*** Any services related to any type of inpatient confinement require authorization
*** Any services rendered by a nonpar provider require authorization unless related to emergency services
Code Type Code Description
CPT
0001F HEART FAILURE ASSESSED
CPT
0006M HEPATIC CARCINOMA TUMOR TISSUE MOPATH ASSAY
CPT
0007M ONCOLOGY GASTRO 51 GENES NOMOGRAM DISEASE INDEX
CPT
0008M ONCOLOGY BREAST MRNA 58 ALGORITHM RISK SCORE
CPT
0009M FETAL ANEUPLOIDY 21 18 SEQ ANALY TRISOM RISK
CPT
00100 ANESTHESIA FOR PROC ON SALIVARY GLANDS, W/BX
CPT
00102 ANESTHESIA, PROC INVOLVING PLASTIC REPAIR OF CLEFT
CPT
00103 ANESTHESIA FOR RECONSTRUCTIVE PROC, EYELID
CPT
00104 ANESTHESIA, ELECTROCONVULSIVE THERAPY
CPT
0010M ONCOLOGY PROSTATE 4 PROTEINS PROBABILITY SCORE
CPT
00120 ANESTHESIA, PROC ON EXT, MIDDLE, AND INNER EAR W/B
CPT
00124 ANESTHESIA, PROC ON EXT, MIDDLE, AND INNER EAR W/B
CPT
00126 ANESTHESIA, PROC ON EXT, MIDDLE, AND INNER EAR W/B
CPT
0012F Cap bacterial assess
CPT
00140 ANESTHESIA, PROC ON EYE; NOS
CPT
00142 ANESTHESIA, PROC ON EYE; LENS SURGERY
CPT
00144 ANESTHESIA, PROC ON EYE; CORNEAL TRANSPLANT
CPT
00145 ANESTHESIA, PROC ON EYE; VITREORETINAL SURGERY
CPT
00147 ANESTHESIA, PROC ON EYE; IRIDECTOMY
CPT
00148 ANESTHESIA, PROC ON EYE; OPHTHALMOSCOPY
CPT
0014F COMP PREOP ASSESS CATARACT SURG W/ IOL
CPT
0015F MELANOMA FOLLOW UP COMPLETED
CPT
00160 ANESTHESIA, PROC ON NOSE AND ACCESSORY SINUSES; NO
CPT
00162 ANESTHESIA, PROC ON NOSE AND ACCESSORY SINUSES; RA
CPT
00164 ANESTHESIA, PROC ON NOSE AND ACCESSORY SINUSES; BX
CPT
00170 ANESTHESIA, INTRAORAL PROC, W/BX; NOS
CPT
00172 ANESTHESIA, INTRAORAL PROC, W/BX; REPAIR, CLEFT PA
CPT
00174 ANESTHESIA, INTRAORAL PROC, W/BX; EXCISION, RETROP
CPT
00176 ANESTHESIA, INTRAORAL PROC, W/BX; RADICAL SURGERY
CPT
00190 ANESTHESIA, PROC ON FACIAL BONES/SKULL; NOS
CPT
00192 ANESTHESIA, PROC ON FACIAL BONES/SKULL; RADICAL SU
CPT
0019T EXTRACORPOREAL SHOCK WAVE MUSCULOSKELETAL SYSTEM
CPT
00210 ANESTHESIA, INTRACRANIAL PROC; NOS
CPT
00211 ANES INTRACRANIAL CRANIOTOMY/CRANIECTOMY HMTMA
CPT
00212 ANESTHESIA, INTRACRANIAL PROC; SUBDURAL TAPS
CPT
00214 ANESTHESIA, INTRACRANIAL PROC; BURR HOLES
CPT
00215 ANESTHESIA, INTRACRANIAL PROC; CRANIOPLASTY/ELEVAT
CPT
00216 ANESTHESIA, INTRACRANIAL PROC; VASCULAR PROC
CPT
00218 ANESTHESIA, INTRACRANIAL PROC; PROC IN SITTING POS
CPT
00220 ANESTHESIA, INTRACRANIAL PROC; CEREBROSPINAL FLUID
CPT
00222 ANESTHESIA, INTRACRANIAL PROC; ELECTROCOAGULATION,
CPT
00300 ANESTHESIA, HEAD, NECK, POST TRUNK INTEGUMENTARY,
CPT
00320 ANESTHESIA, NECK ORGAN PROC; NOS, AGE 1 YR/OLDER
CPT
00322 ANESTHESIA, NECK ORGAN PROC; THYROID NEEDLE BX
CPT
00326 ANESTHESIA, LARYNX AND TRACHEA PROC; CHILDREN LESS
CPT
00350 ANESTHESIA, PROC ON MAJOR VESSELS, NECK; NOS
CPT
00352 ANESTHESIA, PROC ON MAJOR VESSELS, NECK; SIMPLE LI
CPT
00400 ANESTHESIA, EXTREMITIES, ANTERIOR TRUNK, PERINEUM,
CPT
00402 ANESTHESIA, EXTREMITIES, ANTERIOR TRUNK, PERINEUM,
CPT
00404 ANESTHESIA, EXTREMITIES, ANT TRUNK, PERINEUM, INTE
CPT
00406 ANESTHESIA, EXTREMITIES, ANT TRUNK, PERINEUM, INTE
CPT
00410 ANESTHESIA, EXTREMITIES, ANTERIOR TRUNK, PERINEUM,
CPT
0042T CEREBRAL PERFUSION ANAYSIS, CT W/CONTRST, POSTPROC
CPT
00450 ANESTHESIA, PROC ON CLAVICLE AND SCAPULA; NOS
CPT
00454 ANESTHESIA, PROC ON CLAVICLE AND SCAPULA; BX, CLAV
CPT
00470 ANESTHESIA, PARTIAL RIB RESECTION; NOS
CPT
00472 ANESTHESIA, PARTIAL RIB RESECTION; THORACOPLASTY,
CPT
00474 ANESTHESIA, PARTIAL RIB RESECTION; RADICAL PROC
CPT
00500 ANESTHESIA, ALL PROC ON ESOPHAGUS
CPT
0051T IMPLANT, TOT REPLACEMENT HEART SYSTEM W/RECIPIENT
CPT
00520 ANESTHESIA, CLOSED CHEST PROC; NOS
CPT
00522 ANESTHESIA, CLOSED CHEST PROC; PLEURA NEEDLE BX
CPT
00524 ANESTHESIA, CLOSED CHEST PROC; PNEUMOCENTESIS
CPT
00528 ANESTHESIA, CLOSED CHEST PROC, MEDIASTINOSCOPY AND
CPT
00529 ANESTHESIA, CLOSED CHEST PROC, MEDIASTINOSCOPY AND
CPT
0052T REPLACEMENT/REPAIR, THORACIC UNIT, TOT REPLACEMENT
CPT
00530 ANESTHESIA, PERMANENT TRANSVENOUS PACEMAKER INSERT
CPT
00532 ANESTHESIA, ACCESS TO CENTRAL VENOUS CIRCULATION
CPT
00534 ANESTHESIA, TRANSVENOUS INSERTION/REPLACEMENT, PAC
CPT
00537 ANESTHESIA, CARDIAC ELECTROPHYSIOLOGIC PROC W/ RAD
CPT
00539 ANESTHESIA, TRACHEOBRONCHIAL RECONSTRUCTION
CPT
0053T REPLACEMENT/REPAIR, IMPLANTABLE COMPONENT(S), TOT
CPT
00540 ANESTHESIA, THORACOTOMY PROC, W/SURG THORACOSCOPY;
CPT
00541 ANESTHESIA, THORACOTOMY PROC, W/SURG THORACOSCOPY;
CPT
00542 ANESTHESIA, THORACOTOMY PROC, W/SURG THORACOSCOPY;
CPT
00546 ANESTHESIA, THORACOTOMY PROC, W/SURG THORACOSCOPY;
CPT
00548 ANESTHESIA, THORACOTOMY PROC, W/SURG THORACOSCOPY;
CPT
0054T CPTR-ASST MUSCSKEL NAVIGJ ORTHO FLUOR IMAGES
CPT
00550 ANESTHESIA, STERNAL DEBRIDEMENT
CPT
0055T CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI
CPT
00560 ANESTHESIA, PROC ON HEART, PERICARD, GRT VESSLS, C
CPT
00561 ANESTHESIA, PROC ON HEART, PERICARD, AND GRT VESSL
CPT
00562 ANESTHESIA, PROC ON HEART, PERICARD, AND GRT VESSL
CPT
00563 ANESTHESIA, PROC ON HEART, PERICARD, AND GRT VESSL
CPT
00566 ANESTHESIA, DIRECT CORONARY ARTERY BYPASS GRAFTING
CPT
00567 ANES DIRECT CAB GRAFTING W/ PUMP OXYGENATOR
Effective Date
1/1/2004
7/1/2014
10/1/2014
10/1/2014
7/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
7/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
10/1/2003
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2009
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2009
Term date
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Is Preauth required Additional Parameters
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
Y
N
N
N
N
N
Y
N
N
N
N
N
N
Y
N
Y
Y
Y
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
00580
0058T
00600
00604
00620
00625
00626
00630
00632
00635
00640
00670
00700
00702
0071T
0072T
00730
00740
00750
00752
00754
00756
0075T
0076T
00770
00790
00792
00794
00796
00797
00800
00802
0080T
00810
00820
00830
00832
00834
00836
00840
00842
00844
00846
00848
00851
00860
00862
00864
00865
00866
00868
00870
00872
00873
00880
00882
00902
00904
00906
00908
00910
00912
00914
00916
00918
00920
00921
00922
00924
00926
00928
00930
00932
00934
00936
00938
00940
00942
00944
00948
00950
00952
01112
01120
01130
01140
01150
01160
01170
01173
01180
ANESTHESIA, HEART TRANSPLANT/HEART AND LUNG TRANSP
CRYOPRSRV REPRDTVE TISS OVARIAN
ANESTHESIA, PROC, CERVICAL SPINE AND CORD; NOS
ANESTHESIA, PROC, CERVICAL SPINE AND CORD; PROC W/
ANESTHESIA, PROC, THORACIC SPINE AND CORD; NOS
ANES: THORACIC, SPINE & C/D ANT APPR W/O 1 LNG VNT
ANESTHESIA: THORACIC, SPINE & C/D ANT APPR W/1 LNG
ANESTHESIA, PROC, LUMBAR REGION; NOS
ANESTHESIA, PROC, LUMBAR REGION; LUMBAR SYMPATHECT
ANESTHESIA, PROC, LUMBAR REGION; DIAGNOSTIC/THERAP
ANESTHESIA, MANIPULATION, SPINE, CLOSED PROC, CERV
ANESTHESIA, EXTENSIVE SPINE AND SPINAL CORD PROC
ANESTHESIA, PROC, UPPER ANTERIOR ABDOMINAL WALL; N
ANESTHESIA, PROC, UPPER ANTERIOR ABDOMINAL WALL; P
FOCUSED ULTRASOUND ABLATION OF UTERINE LEIOMYOMATA
FOCUSED ULTRASOUND ABLATION OF UTERINE LEIOMYOMATA
ANESTHESIA, PROC, UPPER POSTERIOR ABDOMINAL WALL
ANESTHESIA, UPPER GI ENDOSCOPY PROC, PROXIMAL DUOD
ANESTHESIA, HERNIA REPAIRS, UPPER ABDOMEN; NOS
ANESTHESIA, HERNIA REPAIRS, UPPER ABDOMEN; LUMBAR
ANESTHESIA, HERNIA REPAIRS, UPPER ABDOMEN; OMPHALO
ANESTHESIA, HERNIA REPAIRS, UPPER ABDOMEN; TRANSAB
TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL
TCAT PLMT XTRC VRT CRTD STENT RS&IPRQ EA VSL
ANESTHESIA, ALL PROC ON MAJOR ABDOMINAL BLOOD VESS
ANESTHESIA, INTRAPERITONEAL PROC, UPPER ABDOMEN, W
ANESTHESIA, UPPER ABD W/LAPAROSCOPY; PARTIAL HEPAT
ANESTHESIA, INTRAPERITONEAL PROC, UPPER ABDOMEN, W
ANESTHESIA, INTRAPERITONEAL PROC, UPPER ABDOMEN, W
ANESTHESIA, INTRAPERITONEAL PROC, UPPER ABDOMEN, W
ANESTHESIA, PROC, LOWER ANTERIOR ABDOMINAL WALL; N
ANESTHESIA, PROC, LOWER ANTERIOR ABDOMINAL WALL; P
EVASC RPR AAA PSEUDOARYSM ABDL AORTA VISC RS&I
ANESTHESIA, LOWER INTESTINAL ENDOSCOPY PROC, DISTA
ANESTHESIA, PROC, LOWER POSTERIOR ABDOMINAL WALL
ANESTHESIA, HERNIA REPAIRS, LOWER ABDOMEN; NOS
ANESTHESIA, HERNIA REPAIRS, LOWER ABDOMEN; VENTRAL
ANESTHESIA, HERNIA REPAIRS, LOWER ABDOMEN, NOS, UN
ANESTHESIA, HERNIA REPAIRS, LOWER ABDOMEN, NOS, IN
ANESTHESIA, INTRAPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, INTRAPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, INTROPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, INTROPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, INTRAPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, INTRAPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, EXTRAPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, EXTRAPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, EXTRAPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, EXTRAPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, EXTRAPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, EXTRAPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, EXTRAPERITONEAL PROC, LOWER ABDOMEN, W
ANESTHESIA, LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE
ANESTHESIA, LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE
ANESTHESIA, PROC ON MAJOR LOWER ABDOMINAL VESSELS;
ANESTHESIA, PROC ON MAJOR LOWER ABDOMINAL VESSELS;
ANESTHESIA, ANORECTAL PROC
ANESTHESIA, RADICAL PERINEAL PROC
ANESTHESIA, VULVECTOMY
ANESTHESIA, PERINEAL PROSTATECTOMY
ANESTHESIA, TRANSURETHRAL PROC (W/URETHROCYSTOSCOP
ANESTHESIA, TRANSURETHRAL PROC (W/URETHROCYSTOSCOP
ANESTHESIA, TRANSURETHRAL PROC (W/URETHROCYSTOSCOP
ANESTHESIA, TRANSURETHRAL PROC (W/URETHROCYSTOSCOP
ANESTHESIA, TRANSURETHRAL PROC (W/URETHROCYSTOSCOP
ANESTHESIA, PROC, MALE GENITALIA(W/OPEN URETHRAL P
ANESTHESIA, PROC, MALE GENITALIA(W/OPEN URETHRAL P
ANESTHESIA, PROC, MALE GENITALIA(W/OPEN URETHRAL P
ANESTHESIA, PROC, MALE GENITALIA(W/OPEN URETHRAL P
ANESTHESIA, PROC, MALE GENITALIA(W/OPEN URETHRAL P
ANESTHESIA, PROC, MALE GENITALIA(W/OPEN URETHRAL P
ANESTHESIA, PROC, MALE GENITALIA(W/OPEN URETHRAL P
ANESTHESIA, PROC, MALE GENITALIA(W/OPEN URETHRAL P
ANESTHESIA, PROC, MALE GENITALIA(W/OPEN URETHRAL P
ANESTHESIA, PROC, MALE GENITALIA(W/OPEN URETHRAL P
ANESTHESIA, PROC, MALE GENITALIA(W/OPEN URETHRAL P
ANESTHESIA, VAGINAL PROC, W/BX; NOS
ANESTHESIA, VAGINAL PROC, W/BX; COLPOTOMY, VAGINEC
ANESTHESIA, VAGINAL PROC, W/BX; VAGINAL HYSTERECTO
ANESTHESIA, VAGINAL PROC, W/BX; CERVICAL CERCLAGE
ANESTHESIA, VAGINAL PROC, W/BX; CULDOSCOPY
ANESTHESIA, VAGINAL PROC, W/BX; HYSTEROSCOPY AND/O
ANESTHESIA, BONE MARROW ASPIRATION AND/OR BX, ANTE
ANESTHESIA, PROC, BONY PELVIS
ANESTHESIA, BODY CAST APPLICATION/REVISION
ANESTHESIA, INTERPELVIABDOMINAL (HINDQUARTER) AMPU
ANESTHESIA, RADICAL PROC, TUMOR, PELVIS, EXCEPT HI
ANESTHESIA, CLOSED PROC INVOLVING SYMPHYSIS PUBIS/
ANESTHESIA, OPEN PROC INVOLVING SYMPHYSIS PUBIS/SA
ANESTHESIA, OPEN REPAIR, FX DISRUPTION, PELVIS
ANESTHESIA, OBTURATOR NEURECTOMY; EXTRAPELVIC
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
01190
01200
01202
01210
01212
01214
01215
01220
01230
01232
01234
01250
01260
01270
01272
01274
01320
01340
01360
01380
01382
01390
01392
01400
01402
01404
01420
01430
01432
01440
01442
01444
01462
01464
01470
01472
01474
01480
01482
01484
01486
01490
01500
01502
01520
01522
0159T
01610
01620
01622
01630
01634
01636
01638
0163T
0164T
01650
01652
01654
01656
0165T
01670
01680
01682
0169T
01710
01712
01714
01716
0171T
0172T
01730
01732
01740
01742
01744
0174T
01756
01758
0175T
01760
01770
01772
01780
01782
01810
01820
01829
01830
01832
01840
ANESTHESIA, OBTURATOR NEURECTOMY; INTRAPELVIC
ANESTHESIA, ALL CLOSED PROC INVOLVING HIP JOINT
ANESTHESIA, ARTHROSCOPIC PROC, HIP JOINT
ANESTHESIA, OPEN PROC INVOLVING HIP JOINT; NOS
ANESTHESIA, OPEN PROC INVOLVING HIP JOINT; HIP DIS
ANESTHESIA, OPEN PROC INVOLVING HIP JOINT; TOTAL H
ANESTHESIA, OPEN PROC INVOLVING HIP JOINT; REVISIO
ANESTHESIA, ALL CLOSED PROC INVOLVING UPPER TWO TH
ANESTHESIA, OPEN PROC INVOLVING UPPER TWO THIRDS,
ANESTHESIA, OPEN PROC INVOLVING UPPER TWO THIRDS,
ANESTHESIA, OPEN PROC INVOLVING UPPER TWO THIRDS,
ANESTHESIA, ALL PROC ON NERVES, MUSCLES, TENDONS,
ANESTHESIA, ALL PROC INVOLVING VEINS, UPPER LEG, W
ANESTHESIA, UPPER LEG ARTERY PROC W/BYPASS GRAFT;
ANESTHESIA, UPPER LEG ARTERY PROC W/BYPASS GRAFT;
ANESTHESIA, UPPER LEG ARTERY PROC W/BYPASS GRAFT;
ANESTHESIA, NERVES, MUSCLES, TENDONS, FASCIA AND B
ANESTHESIA, ALL CLOSED PROC ON LOWER ONE THIRD, FE
ANESTHESIA, ALL OPEN PROC ON LOWER ONE THIRD, FEMU
ANESTHESIA, ALL CLOSED PROC ON KNEE JOINT
ANESTHESIA, DX ARTHROSCOPIC PROC, KNEE JOINT
ANESTHESIA, ALL CLOSED PROC ON UPPER ENDS, TIBIA,
ANESTHESIA, ALL OPEN PROC ON UPPER ENDS, TIBIA, FI
ANESTHESIA, OPEN/SURG ARTHROSCOPIC PROC, KNEE JOIN
ANESTHESIA, OPEN/SURG ARTHROSCOPIC PROC, KNEE JOIN
ANESTHESIA, OPEN/SURG ARTHROSCOPIC PROC, KNEE JOIN
ANESTHESIA, ALL CAST APPLICATIONS, REMOVAL/REPAIR
ANESTHESIA, PROC ON VEINS, KNEE AND POPLITEAL AREA
ANESTHESIA, PROC ON VEINS, KNEE AND POPLITEAL AREA
ANESTHESIA, ARTERIES, KNEE AND POPLITEAL AREA; NOS
ANESTHESIA, ARTERIES, KNEE AND POPLITEAL AREA; POP
ANESTHESIA, ARTERIES, KNEE AND POPLITEAL AREA; POP
ANESTHESIA, ALL CLOSED PROC, LOWER LEG, ANKLE, AND
ANESTHESIA, ARTHROSCOPIC PROC, ANKLE AND/OR FOOT
ANESTHESIA, NERVES/MUSCLES/TENDONS AND FASCIA, LOW
ANESTHESIA, NERVES/MUSCLES/TENDONS AND FASCIA, LOW
ANESTHESIA, NERVES/MUSCLES/TENDONS AND FASCIA, LOW
ANESTHESIA, OPEN PROC, BONES, LOWER LEG/ANKLE/FOOT
ANESTHESIA, OPEN PROC, BONES, LOWER LEG,ANKLE AND
ANESTHESIA, OPEN PROC, BONES, LOWER LEG/ANKLE/FOOT
ANESTHESIA, OPEN PROC, BONES, LOWER LEG/ANKLE/FOOT
ANESTHESIA, LOWER LEG CAST APPLICATION, REMOVAL/RE
ANESTHESIA, ARTERIES LOWER LEG PROC W/BYPASS GRAFT
ANESTHESIA, ARTERIES LOWER LEG PROC W/BYPASS GRAFT
ANESTHESIA, PROC ON VEINS, LOWER LEG; NOS
ANESTHESIA, PROC ON VEINS, LOWER LEG; VENOUS THROM
Cad breast mri
ANESTHESIA, NERVES/MUSCLES/TENDONS/FASCIA AND BURS
ANESTHESIA, CLOSED PROC, HUMERAL HEAD AND NECK/STE
ANESTHESIA, DX ARTHROSCOPIC PROC, SHOULDER JOINT
ANESTHESIA, OPEN/SURG ARTHROSCOPIC PROC, HUMERAL H
ANESTHESIA, OPEN/SURG ARTHROSCOPIC PROC, HUMERAL H
ANESTH, OPEN/SURG ARTHROSCOP PROC, HUMER HEAD AND
ANESTHESIA, OPEN/SURG ARTHROSCOPIC PROC, HUMERAL H
Lumb artif diskectomy addl
Remove lumb artif disc addl
ANESTHESIA, PROC ON ARTERIES, SHOULDER AND AXILLA;
ANESTHESIA, PROC ON ARTERIES, SHOULDER AND AXILLA;
ANESTHESIA, PROC ON ARTERIES, SHOULDER AND AXILLA;
ANESTHESIA, PROC ON ARTERIES, SHOULDER AND AXILLA;
Revise lumb artif disc addl
ANESTHESIA, ALL PROC ON VEINS, SHOULDER AND AXILLA
ANESTHESIA, SHOULDER CAST APPLICATION, REMOVAL/REP
ANESTHESIA, SHOULDER CAST APPLICATION, REMOVAL/REP
Place stereo cath brain
ANESTHESIA, NERVES/MUSCLES/TENDONS/FASCIA AND BURS
ANESTHESIA, NERVES/MUSCLES/TENDONS/FASCIA AND BURS
ANESTHESIA, NERVES/MUSCLES/TENDONS/FASCIA AND BURS
ANESTHESIA, NERVE/MUSCL/TENDON/FASCIA AND BURSAE,
Lumbar spine proces distract
Lumbar spine proces addl
ANESTHESIA, ALL CLOSED PROC ON HUMERUS AND ELBOW
ANESTHESIA, DX ARTHROSCOPIC PROC, ELBOW JOINT
ANESTHESIA, OPEN/SURG ARTHROSCOPIC PROC, ELBOW; NO
ANESTHESIA, OPEN PROC ON HUMERUS AND ELBOW; OSTEOT
ANESTHESIA, OPEN PROC ON HUMERUS AND ELBOW; REPAIR
Cad cxr with interp
ANESTHESIA, OPEN PROC ON HUMERUS AND ELBOW; RADICA
ANESTHESIA, OPEN PROC ON HUMERUS AND ELBOW; EXCISI
Cad cxr remote
ANESTHESIA, OPEN PROC ON HUMERUS AND ELBOW; TOTAL
ANESTHESIA, PROC ON ARTERIES, UPPER ARM AND ELBOW;
ANESTHESIA, PROC ON ARTERIES, UPPER ARM AND ELBOW;
ANESTHESIA, PROC ON VEINS, UPPER ARM AND ELBOW; NO
ANESTHESIA, PROC ON VEINS, UPPER ARM AND ELBOW; PH
ANESTHESIA, NERVES/MUSCLES/TENDONS/FASCIA AND BURS
ANESTHESIA, ALL CLOSED PROC ON RADIUS, ULNA, WRIST
ANESTHESIA, DX ARTHROSCOPIC PROCEDURES, WRIST
ANESTHESIA, OPEN/SURG ARTHROSCOPIC/ENDOSCOPIC PROC
ANESTHESIA, OPEN/SURG ARTHROSC/ENDOSCOP PROC, DISTL RADI
ANESTHESIA, PROC ON ARTERIES, FOREARM, WRIST, AND
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N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
01842
01844
0184T
01850
01852
01860
0188T
0189T
0190T
01916
0191T
01920
01922
01924
01925
01926
01930
01931
01932
01933
01935
01936
01951
01952
01953
01958
0195T
01960
01961
01962
01963
01965
01966
01967
01968
01969
0196T
0198T
01990
01991
01992
01996
01999
0200T
0201T
0202T
0205T
0206T
0207T
0208T
0209T
0210T
0211T
0212T
0213T
0214T
0215T
0216T
0217T
0218T
0219T
0220T
0221T
0222T
0223T
0224T
0225T
0228T
0229T
0230T
0231T
0232T
0233T
0234T
0235T
0236T
0237T
0238T
0240T
0241T
0243T
0244T
0249T
0253T
0254T
0255T
0262T
0263T
0264T
0265T
0266T
ANESTHESIA, PROC ON ARTERIES, FOREARM, WRIST, AND
ANESTHESIA, VASCULAR SHUNT/SHUNT REVISION, ANY TYP
RECTAL TUMOR EXCISION TRANSANAL ENDOSCOPIC
ANESTHESIA, PROC ON VEINS, FOREARM, WRIST, AND HAN
ANESTHESIA, PROC ON VEINS, FOREARM, WRIST, AND HAN
ANESTHESIA, FOREARM/WRIST/HAND CAST APPLICATION, R
VIDEOCONFERENCED CRITICAL CARE FIRST 30- 74 MIN
VIDEOCONFERENCED CRITICAL CARE EA ADDL 30 MIN
INTRAOCULAR RADIATION SRC APPLICATOR PLACEMENT
ANESTHESIA, DX ARTERIOGRAPHY/VENOGRAPHY
ANT SEGMENT INSERTION DRAINAGE W/O RESERVOIR INT
ANESTHESIA, CARDIAC CATHETERIZATION W/CORONARY ART
ANESTHESIA, NON-INVASIVE IMAGING/RADIATION THERAPY
ANESTHESIA, THERAPEUTIC INTERVENTIONAL RADIOL, ART
ANESTHESIA, THERAPEUTIC INTERVENTIONAL RADIOL, ART
ANESTHESIA, THERAPEUTIC INTERVENTIONAL RADIOL, ART
ANES, THERAPEUTIC INTERVEN RADIOL, VENOUS/LYMPHATI
ANES, THERAP INTERVEN RADIOL, VENOUS/LYMPHATIC SYS
ANES, THERAP INTERVEN RADIOL, VENOUS/LYMPHATIC SYS
ANES, THERAP INTERVEN RADIOL, VENOUS/LYMPHATIC SYS
ANESTHESIA PERQ IMG GID SPINE DIAGNOSTIC
ANESTHESIA PERQ IMG GID SPINE THERAPEUTIC
ANESTHESIA 2ND AND 3RD DEGREE BURN EXCISION/DEBRID
ANESTHESIA 2ND AND 3RD DEGREE BURN EXCIS/DEBRIDEME
ANESTHESIA 2ND AND 3RD DEGREE BURN EXCISION/DEBRID
ANESTHESIA, EXTERNAL CEPHALIC VESION PROC
ARTHRODESIS, PRE-SACRAL INTERBODY TECHNIQUE, DISC SPACE PREPARATION, DISCECTOMY
ANESTHESIA FOR VAGINAL DELIVERY ONLY
ANESTHESIA FOR CESAREAN DELIVERY ONLY
ANESTHESIA FOR URGENT HYSTERECTOMY FOLLOWING DELIV
ANESTHESIA FOR CESAREAN HYSTERECTOMY W/O ANY LABOR
ANES INC/MISSED ABORT
ANES INDUCED ABORT
NEURAXIAL LABOR ANALGESIA/ANESTHESIA, PLANNED VAGI
ANESTHESIA FOR CESAREAN DELIVERY FOLLOWING NEURAXI
ANES FOR CESAREAN HYSTERECTOMY FOLLOWING NEURAXIAL
ARTHRODESIS, PRE-SACRAL INTERBODY TECHNIQUE, DISC SPACE PREPARATION, DISCECTOMY
OCULAR BLOOD FLOW MEASUREMENT
PHYSIOLOGICAL SUPPORT, HARVESTING, ORGAN(S), BRAIN
ANES DX/THER NRV BLK/NJX OTH/THN PRONE POS
ANES DX/THER NERVE BLOCK/INJECTION PRONE POS
DAILY HOSPITAL MANAGEMENT, EPIDURAL/SUBARACHNOID C
UNLISTED ANESTHESIA PROC(S)
PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL
PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS
POST VERTEB JOINT ARTHROPLASTY SINGLE LUMBAR
IVASC VESSEL/GRAFT SPECTROSCOPY+-TX INVTJ W/RSI
CPTR DBS ALYS MLT CYCLS CAR ELEC DTA 2/> ECG LDS
EVAC MEIBOMIAN GLANDS W/HEAT& INTMT PRESSURE
PURE TONE AUDIOMTRY THRESHOLD COMPUTER DEV AIR
PURE TONE AUDIOMTRY THRESHOLD CPTR DEV AIR&BONE
SPEECH AUDIOMTRY THRESHOLD CPTR DEVICE AIR&BONE
SPEECH AUDIOMTRY THRESHOLD AIR&BN SPEECH RECOG
COMPREHNS AUDIOMTRY THRESHOLD EVAL&SPEECH RECOG
INJECT PARAVERT FACET JT/NERVE CERV/THORAC 1LVL
INJECT PARAVER FACET JT/NERVE CERV/THORAC LVL 2
INJECT PARAVER FACET JT/NERVE CERV/THORAC 3+LVL
INJECTION PARAVERT FACET JT/NERVE LMBR/SAC 1LVL
INJECTION PARAVERT FACET JT/NERVE LMBR/SAC LVL2
INJECTION PARAVER FACET JT/NERVE LMBR/SAC 3+LVL
PLACE POSTR INFACET IMPLANT GRAFT/DEV 1LVL CERV
PLACE POSTR INFACET IMPLANT GRAFT/DEV 1LVL THOR
PLACE POSTR INFACET IMPLANT GRAFT/DEV 1LVL LMBR
PLACE POSTR INFACET IMPLANT GRAFT/DEV 1LV +LVL
ACOUSTIC/ELECTR CARDGRPHY COMB SINGLE W/INT&REPT
ACSTIC/ELECT CARDGRPHY MULTI AV/VV W/INT&REPT
ACSTIC/ELECT CARDGRPHY MULTI AV+VV W/INT&REPT
INJ ANES AGT&/STRD TFRML EDRL US CRV/THRC 1LVL
INJ ANES AGT&/STRD TFRML EDRL US CRV/THRC + LVL
INJ ANES AGT&/STRD TFRML EDRL US LMBR/SAC 1LVL
INJ ANES AGT&/STRD TFRML EDRL US LMBR/SAC + LVL
NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
SKN AGE MEAS MLT-WVELNGTH FLUOR SPCTRSCPY
TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA
TRLUML PERIPHERAL ATHERECTOMY VISCERAL ARTERY EA
TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA
TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL
TRLUML PERIPHERAL ATHERECTOMY ILIAC ARTERY EA
ESOPH MOTILITY 3D PRESSURE TOPOGRAPHY W/I&R
ESOPH/GASTROESOPH MOTILITY W/STIM/PERFU W/I&R
INTERMIT MEAS WHEEZE RATE BRONCHODIL DX W/I&R
CONT MEAS WHEEZE RATE BRONCHODIL SLEEP 3-24 HRS
LIGATION HEMORRHOID BUNDLE W/US
INSERT ANT SGM DRAINAGE DEV W/O RESERVR INT APPR
EVASC ILIAC ART BIFURC W/ENDOPROSTH UNI
EVASC ILIAC ART BIFURC W/ENDOPROSTH UNI RS&I
IMPLTJ CATH-DLVR PRSTHC PULM VLV EVASC APPR
IM AUTOL B1 MRW CEL THER 1 LEG COMPL INCL HRVST
IM AUTOL B1 MRW CEL THER 1 LEG COMPL XCL HRVST
IM AUTOL B1 MRW CEL THER UNI/BI HRVST ONLY
IMPLTJ/RPLCMT CRTD SNS BRORFLX ACTV DEV TOT SYS
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
0267T
0268T
0269T
0270T
0271T
0272T
0273T
0274T
0275T
0278T
0281T
0282T
0283T
0284T
0285T
0286T
0287T
0288T
0289T
0290T
0291T
0292T
0293T
0294T
0295T
0296T
0297T
0298T
0299T
0300T
0301T
0302T
0303T
0304T
0305T
0306T
0307T
0308T
0309T
0310T
0311T
0312T
0313T
0314T
0315T
0316T
0317T
0329T
0330T
0331T
0332T
0333T
0335T
0336T
0337T
0338T
0339T
0340T
0341T
0342T
0345T
0346T
0347T
0348T
0349T
0350T
0351T
0352T
0353T
0354T
0355T
0356T
0357T
0358T
0359T
0360T
0361T
0362T
0363T
0364T
0365T
0366T
0367T
0368T
0369T
0370T
0371T
0372T
0373T
0374T
0375T
IMPLTJ/RPLCMT CRTD SNS BRORFLX ACTV DEV LEAD UNI
IMPLTJ/RPLCMT CRTD SNS BRORFLX ACTV DEV PLS GEN
REV/REMVL CRTD SNS BRORFLX ACTV DEV TOT SYS
REV/REMVL CRTD SNS BRORFLX ACTV DEV LEAD UNI
REV/REMVL CRTD SNS BRORFLX ACTV DEV PLS GEN
INTERROGATION EVAL CRTD SNS BRORFLX ACTV SYS
INTERROGATION EVAL CRTD SNS BRORFLX W/PROGRMG
PERC LAMINO-/LAMINECTOMY IMAGE GUIDE CERV/THORAC
PERC LAMINO-/LAMINECTOMY INDIR IMAG GUIDE LUMBAR
TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS
PERC TRANSCTH CLOSR LT ATRIAL APPNDGE IMPLNT S&I
PERC/OPEN IMPLNT NEUROSTIM ELECTRODE SUBQ TRIAL
PERC/OPEN IMPLNT NEUROSTIM ELECTRODE SUBQ PERM
REV/REMVL PG/ELCTRODES IMAGNG ADDN NEW ELCTRODES
ELEC ANLYS IMPLANT SUBQ FIELD STIM PG REPROGRAMM
NEAR INFRARED SPECTROSCPY STUDIES LOW EXT WOUNDS
NEARINFRED GUIDANCE VASC ACES RL TIME DIG VISU
ANSCPY W/DELVRY THERMAL ENERGY MUSCLE ANAL CANAL
CORNEA INCISNS DONOR CORNEA W/LASR KERTPLSTY
CORNEA INCISNS RECIPIENT CORNEA W/LASR KERTPLSTY
INTRAV OPTCL CHERNCE TMGRPHY W/S&I INJ INTL VESL
INTRAV OPTCAL COHRNCE TMGRPHY W/S&I ADL VESL
INS LT ATRL HEMODYN MOTR CMPLETE SYST W/S&I
INS LT ATRL HEMDYN MTR PRSR SENSR LEAD W/S&I
EXT ECG > 48HR TO 21 DAY RCRD SCAN ANLYS REP R&I
EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD
EXT ECG > 48HR TO 21 DAY SCAN ANALYSIS W/REPORT
EXT ECG > 48HR TO 21 DAY REVIEW AND INTERPRETATN
ESW H ENERGY W/TOPCAL APP &DRESNG CARE 1ST WOUND
ESW H ENERGY W/TOPCAL APP &DRESNG CARE ADL WOUND
DEST/REDUC MALIG BRST TUMR W/US THRMORX GUIDANCE
INSJ/RMVL RPLCMT ICAR ISCHM MNTRNG SYS COMPL
INSJ/RMVL RPLCMT ICAR ISCHM MNTRNG SYS ELTRD
INSJ/RMVL RPLCMT ICAR ISCHM MNTRNG SYS DEVICE
PROGRAM EVAL ICAR ISCHM MNTRNG SYS
INTERROGATION EVAL ICAR ISCHM MNTRNG SYS
RMVL INTRACARDIAC ISCHEMIA MONITORING DEVICE
INSJ OCULAR TELESCOPE PROSTH
ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L4/L5
MOTOR FUNCTION MAPPING NAVIGATED TMS TX PLAN
N-INVAS CAL & ALYS CNTRL ARTL PRESSURE WAVEFORM
LAPS IMPLTJ NSTIM ELTRD ARRAY&PLS GEN VAGUS NRV
LAPS REVJ/REPLCMT NSTIM ELTRD ARRAY VAGUS NRV
LAPS RMVL NSTIM ELTRD ARRAY & PLS GEN VAGUS NRV
REMOVAL PULSE GENERATOR VAGUS NERVE
REPLACEMENT PULSE GENERATOR VAGUS NERVE
ELEC ALYS NSTIM PLS GEN VAGUS NRV W/REPRGRMG
MNTR INTRAOCULAR PRESS 24HRS/> UNI/BI W/INTERP
TEAR FILM IMAGING UNILATERAL OR BILATERAL W/I&R
MYOCRD SYMPATHETIC INNERVAJ IMG PLNR QUAL&QUANT
MYOCRD SYMP INNERVAJ IMG PLNR QUAL&QUANT W/SPECT
VISUAL EVOKED POTENTIAL ACUITY SCREENING AUTO
EXTRA-OSSEOUS JOINT IMPLANT TALOTARSAL STABILJ
LAPS ABLATJ UTERINE FIBROIDS W/ INTRAOP US GDNC
ENDOTHELIAL FUNCTION ASSESSMENT NON-INVASIVE
TRANSCATHETER RENAL SYMPATH DENERVATION UNILAT
TRANSCATHETER RENAL SYMPATH DENERVATION BILAT
ABLATE PULM TUMORS W/ PLEURA/CHEST WALL EXTSN
QUANT PUPILLOMETRY W/ INTERP&REPORT UNILAT/BILAT
THERAPEUTIC APHERESIS W/ SELECTIVE HDL DELIP
TRANSCATH MITRAL VALVE REPAIR VIA CORONARY SINUS
ULTRASOUND ELASTOGRAPHY
PLACE INTERSTITIAL DEVICE(S) IN BONE FOR RSA
RADIOSTEREOMETRIC ANALYSIS SPINE EXAM
RADIOSTEREOMETRIC ANALYSIS UPPER EXTREMITY EXAM
RADIOSTEREOMETRIC ANALYSIS LOWER EXTREMITY EXAM
INTRAOP OCT BREAST OR AXILL NODE EACH SPECIMEN
OCT BREAST OR AXILL NODE SPECIMEN I&R
OCT OF BREAST SURG CAVITY REAL TIME INTRAOP
OCT BREAST SURG CAVITY REAL TIME/REFERRED I&R
GI TRACT IMAGING INTRALUMINAL COLON WITH I&R
7INSERT DRUG IMPLANT INTO LACRIMAL CANAL FOR IOP
CRYOPRESERVATION IMMATURE OOCYTE(S)
BIA WHOLE BODY SUPINE POSTION WITH I&R
BEHAVIORAL IDENTIFICATION ASSESSMENT
OBSERVATIONAL BEHAV ASSESSMENT FIRST 30 MIN
OBSERVATIONAL BEHAV ASSESSMENT ADDL 30 MIN
EXPOSURE BEHAV ASSESSMENT FIRST 30 MIN
EXPOSURE BEHAV ASSESSMENT ADDL 30 MIN
BEHAVIOR TREATMENT BY PROTOCOL FIRST 30 MIN
BEHAVIOR TREATMENT BY PROTOCOL ADDL 30 MIN
GROUP BEHAVIOR TREATMENT FIRST 30 MIN
GROUP BEHAVIOR TREATMENT ADDL 30 MIN
BEHAVIOR TREATMENT WITH MODIFICATION 30 MIN
BEHAVIOR TREATMENT WITH MODIFICATION ADDL 30 MIN
FAMILY BEHAVIOR TREATMENT GUIDANCE
MULTIPLE FAMILY GROUP BEHAV TREATMENT GUIDANCE
BEHAVIOR TREATMENT SOCIAL SKILLS TRAINING GROUP
EXPOSURE BEHAVIOR TREATMENT FIRST 30 MIN
EXPOSURE BEHAVIOR TREATMENT ADDL 30 MIN
TOTAL DISC ARTHRP ANT APPR W/DISCECTOMY CRV 3+
7/1/2011
7/1/2011
7/1/2011
7/1/2011
7/1/2011
7/1/2011
7/1/2011
7/1/2011
7/1/2011
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
7/1/2012
7/1/2012
7/1/2012
7/1/2012
7/1/2012
7/1/2012
7/1/2012
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
7/1/2013
7/1/2013
7/1/2013
7/1/2013
7/1/2013
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
7/1/2014
1/1/2015
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
0376T
0377T
0378T
0379T
0380T
0381T
0382T
0383T
0384T
0385T
0386T
0387T
0388T
0389T
0390T
0391T
0392T
0393T
0394T
0395T
0396T
0397T
0398T
0399T
0400T
0401T
0402T
0403T
0404T
0405T
0406T
0407T
0500F
0501F
0502F
0503F
0505F
0507F
0513F
0514F
0516F
0517F
0518F
0519F
0520F
0521F
0525F
0526F
0528F
0529F
0535F
0540F
0545F
0550F
0551F
0555F
0556F
0557F
0575F
0580F
0581F
0582F
0583F
0584F
098PO
1000F
10021
10022
1002F
10030
10035
10036
10040
10060
10061
10080
10081
1010F
1011F
10120
10121
1012F
10140
1015F
10160
10180
1018F
1019F
1022F
1026F
1030F
ANT SEGMENT INSERT DRAIN W/O RESERVOIR EA ADDL
ANOSCOPY W/BULKING AGENT INJ FOR FECAL INCONT
VISUAL FIELD ASSESSMENT PHYS REVIEW AND REPORT
VISUAL FIELD ASSESSMENT TECH SUPPORT W/INSTRUCT
COMP ANIMATION RETINA IMAGE TIME SERIES ANALYSIS
EXT HEART RATE FOR EPI SZ UP TO 14 DAYS COMPLETE
EXT HEART RATE FOR EPI SZ UP TO 14 DAYS R&I ONLY
EXT HEART RATE FOR EPI SZ UP TO 30 DAYS COMPLETE
EXT HEART RATE FOR EPI SZ UP TO 30 DAYS R&I ONLY
EXT HEART RATE FOR EPI SZ OVER 30 DAYS COMPLETE
EXT HEART RATE FOR EPI SZ OVER 30 DAYS R&I ONLY
TRANSCATH INSERT OR REPLACE LEADLESS CA PM VENTR
TRANSCATH REMOVAL LEADLESS CA PM VENTR
PROG DEVICE EVAL IN PERSON LEADLESS PM SYSTEM
PERI-PROC DEVICE EVAL IN PERS LEADLESS PM SYSTEM
INTERROG DEVICE EVAL IN PERSON LEADLESS PM SYST
LAPAROSCOPY, SURGICAL, ESOPHAGEAL SPHINCTER AUGMENTATION PROCEDURE, PLACEMEN
REMOVAL OF ESOPHAGEAL SPHINCTER AUGMENTATION DEVICE
HIGH DOSE RATE ELECTRONIC BRACHYTHERAPY, SKIN SURFACE APPLICATION, PER FRACTION,
HIGH DOSE RATE ELECTRONIC BRACHYTHERAPY, INTERSTITIAL OR INTRACAVITARY TREATMEN
INTRA-OPERATIVE USE OF KINETIC BALANCE SENSOR FOR IMPLANT STABILITY DURING KNEE R
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP), WITH OPTICAL ENDOMIC
MAGNETIC RESONANCE IMAGE GUIDED HIGH INTENSITY FOCUSED ULTRASOUND (MRGFUS), S
MYOCARDIAL STRAIN IMAGING (QUANTITATIVE ASSESSMENT OF MYOCARDIAL MECHANICS U
MULTI-SPECTRAL DIGITAL SKIN LESION ANALYSIS OF CLINICALLY ATYPICAL CUTANEOUS PIGME
MULTI-SPECTRAL DIGITAL SKIN LESION ANALYSIS OF CLINICALLY ATYPICAL CUTANEOUS PIGME
COLLAGEN CROSS-LINKING OF CORNEA (INCLUDING REMOVAL OF THE CORNEAL EPITHELIUM A
PREVENTIVE BEHAVIOR CHANGE, INTENSIVE PROGRAM OF PREVENTION OF DIABETES USING A
TRANSCERVICAL UTERINE FIBROID(S) ABLATION WITH ULTRASOUND GUIDANCE, RADIOFREQU
OVERSIGHT OF THE CARE OF AN EXTRACORPOREAL LIVER ASSIST SYSTEM PATIENT REQUIRING
NASAL ENDOSCOPY, SURGICAL, ETHMOID SINUS, PLACEMENT OF DRUG ELUTING IMPLANT;
NASAL ENDOSCOPY, SURGICAL, ETHMOID SINUS, PLACEMENT OF DRUG ELUTING IMPLANT; W
INITIAL PRENATAL CARE VISIT(REPORT OF 1ST PRENATAL
PRENATAL FLOW SHEET DOCUMENTED IN MEDICAL RECORD B
SUBSEQUENT PRENATAL CARE VISIT
POSTPARTUM CARE VISIT
Hemodialysis plan documented
Periton dialysis plan documented
ELEVATED BLOOD PRESSURE PLAN OF CARE DOCUMENTED
PLAN/CARE INCRSD HGB LVL DOCD PT ON ESA TH
ANEMIA PLAN OF CARE DOCUMENTED
GLAUCOMA PLAN OF CARE DOCUMENTED
FALLS PLAN OF CARE DOCUMENTED
PLAND CHEMO REG DOCD B/4 START NEW TXMNT
RAD DOS LIMTS ESTABD B/4 3D RAD FOR MIN 2 TISS
PLAN OF CARE TO ADDRESS PAIN DOCD
INITIAL VISIT FOR EPISODE
SUBSEQUENT VISIT FOR EPISODE
RCMND FLW-UP 10 YRS DOCD
INTRVL 3+YRS PTS CLNSCP DOCD
DYSPNEA MNGMNT PLAN DOCD
GLUCO MNGMNT PLAN DOCD
PLAN FOR FOLLOW-UP CARE FOR MDD DOCD
CYTOPATH REPORT ON NONGYN SPECIMEN - 2 WKNG DAYS
CYTOPATH REPORT - NONGYN SPCMN DOCD NON-ROUTINE
SYMPTOM MANAGEMENT PLAN OF CARE DOCUMENTED
PLAN OF CARE TO ACHIEVE LIPID CONTROL DOCUMENTED
PLAN OF CARE TO MANAGE ANGINAL SYMPTOMS DOCD
HIV RNA CONTROL PLAN OF CARE DOCD
MULTIDISCIPLINARY CARE PLAN DEVELOPED/UPDATED
PT TRANSFERRED FROM ANESTHETIZING TO CC UNIT
PT NOT TRANSFERRED FROM ANESTHETIZING TO CC UNIT
TRANSFER OF CARE CHECKLIST USED
TRANSFER OF CARE CHECKLIST NOT USED
SRVC PROC&/SURG PRVD OFF-CAMPUS PRVD-BSD OP DEPT
TOBACCO USE, SMOKE, ASSESSED
FINE NEEDLE ASIPIRATION;WITHOUT IMAGING GUIDANCE
FINE NEEDLE ASPIRATION; W/IMAGING GUIDANCE
ANGINAL SYMPTOMS&LVL ACTV ASSESSED
IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE
PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEE
PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEE
ACNE SURGERY
INCISION AND DRAINAGE, ABSCESS; SIMPLE/SINGLE
INCISION AND DRAINAGE OF ABSCESS; COMPLICATED OR M
INCISION AND DRAINAGE, PILONIDAL CYST; SIMPLE
INCISION AND DRAINAGE OF PILONDIAL CYST; COMPLICAT
SEVERITY OF ANGINA ASSESSED BY LEVEL OF ACTIVITY
ANGINA PRESENT
INCISION AND REMOVAL, FB, SUBQ TISSUES; SIMPLE
INCISION AND REMOVAL, FB, SUBQ TISSUES; COMPLICATE
ANGINA ABSENT
INCISION AND DRAINAGE, HEMATOMA, SEROMA/FLUID COLL
Copd symptoms assess
PUNCTURE ASPIRATION, ABSCESS, HEMATOMA, BULLA/CYST
INCISION & DRAINAGE, COMPLEX POST OPERATIVE
Assess dyspnea not present
Assess dyspnea present
Pneumo imm status assess
Co-morbid condition assess
Influenza imm status assess
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2010
7/1/2011
7/1/2011
1/1/2012
1/1/2012
1/1/2012
10/1/2008
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2015
1/1/2004
1/1/2013
1/1/2004
1/1/2004
1/1/2014
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
1031F
1032F
1033F
1034F
1035F
1036F
1038F
1039F
1040F
1050F
1052F
1055F
1090F
11000
11001
11004
11005
11006
11008
11010
11011
11012
1101F
11042
11043
11044
11045
11046
11047
11055
11056
11057
11100
11101
1118F
1119F
11200
11201
1121F
1123F
1124F
1125F
1126F
1127F
1128F
11300
11301
11302
11303
11305
11306
11307
11308
1130F
11310
11311
11312
11313
1134F
1135F
1136F
1137F
11400
11401
11402
11403
11404
11406
11420
11421
11422
11423
11424
11426
11440
11441
11442
11443
11444
11446
11450
11451
11462
11463
11470
11471
1150F
1151F
1152F
1153F
1157F
SMOKING-2ND HAND SMOKE IN THE HOME ASSESSED
CURRENT SMOKER/EXPOSED TO SECONDHAND SMOKE
TOBACCO NON-SMOKER +NO 2NDHAND SMOKE EXPOSURE
Current tobacco smoker
Smokeless tobacco user
CURRENT TOBACCO NON-USER CAD CAP COPD PV DM
Persistent asthma
Intermittent asthma
DSM-IV(TM) CRITERIA MDD DOCD AT THE INITIAL EVAL
History of mole changes
TYPE ANATOMIC LOCATION AND ACTIVITY ALL ASSESSED
Visual funct status assess
Presence or absence of urinary incontinence assessed (GER)
DEBRIDEMENT, EXTENSIVE ECZEMATOUS/INFECTED SKIN; U
DEBRIDEMENT, EXTENSIVE ECZEMATOUS, EACH ADDL 10%
DEBRIDEMENT, EXTERNAL GENITALIA AND PERINEUM
DEBRIDEMENT, ABDOMINAL WAL, WITH/WO FASCIAL CLOSUR
DEBRIDEMENT, EXTERNAL GENITALIA, PERIEUM , AND ABD
REMOVAL OF PROSTHETIC MATERIAL OR MESH
DBRDMT W/RMVL FM FX&/DISLC SKN&SUBQ TISS
DEBRIDEMENT W/REMOVAL FOREIGN MATL, OPEN FX/DISLOC
DBRDMT FX&/DISLC SUBQ T/M/F BONE
PATIENT SCREENED FOR FUTURE FALL; DOCUMENT OF NO FALLS IN PAST YEAR
DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<
DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<
DBRDMT BONE M&/F 20 SQ CM/<
DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
DBRDMT M&/F EA ADDL 20 SQ CM
DEBRIDEMENT BONE EA ADDL 20 SQ CM/<
PARING/CUTTING, BENIGN HYPERKERATOTIC LESION; SING
PARING/CUTTING, BENIGN HYPERKERATOTIC LESION; 2-4
PARING/CUTTING, BENIGN HYPERKERATOTIC LESION; GREA
BX, SKIN, SUBQ/MUCOUS MEMBRANE; SINGLE LESION
BX, SKIN, SUBQ/MUCOUS MEMBRANE (SEP PROC); ADDL LE
GERD SYMPTOMS ASSESSED AFTER 12 MONTHS OF THXPY
INITIAL EVALUATION FOR CONDITION
REMOVAL, SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS,
REMOVAL, SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS,
SUBSEQUENT EVALUATION FOR COND
ADV CARE PLN TLKD & ALT DCSN MAKER DOCD
ADV CARE PLN/ NO ALT DCSN MKR DOCD OR REFUSAL
PAIN SEVERITY QUANTIFIED; PAIN PRESENT
PAIN SEVERITY QUANTIFIED; NO PAIN PRESENT
NEW EPISODE FOR CONDITION
SUBSEQUENT EPISODE FOR CONDITION
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.5
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 0.6
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER 1.1
SHAVING SKIN LESION, TRUNK/ARMS/LEGS; DIAMETER OVE
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITAL
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITAL
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITAL
SHAVING SKIN LESION, SCALP/NECK/HANDS/FEET/GENITAL
BK PAIN & FXN ASSESSED CERTAIN ASPECTS OF CARE
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/M
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/M
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/M
SHAVING SKIN LESION, FACE/EARS/EYELIDS/NOSE/LIPS/M
EPISODE OF BACK PAIN LASTING SIX WEEKS OR LESS
EPISODE OF BACK PAIN LASTING LONGER THAN SIX WK
EPISODE OF BACK PAIN LASTING 12 WEEKS OR LESS
EPISODE OF BACK PAIN LASTING LONGER THAN 12 WKS
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT S
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT S
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT S
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT S
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT S
EXCISE, BENIGN SKIN LESION, INCL MARGINS, EXCEPT S
EXCISE BENIGN SKIN LESION W/MARG, EXCPT SKIN TAG S
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCA
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCA
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCA
EXCISE BEN SKIN LESION W/MARG, EXCEPT SKIN TAG SCA
EXCISE BENIGN SKIN LESION W/MARG, EXCEPT SKIN TAG
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EAR
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EAR
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EAR
EXCISION, BENIGN LESION, DIAMETER 2.1 TO 3.0 CM
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EAR
EXCISE, BENIGN SKIN LESION, INCL MARGINS, FACE/EAR
EXCISION, SKIN AND SUBQ TISSUE, HIDRADENITIS, AXIL
EXCISION, SKIN ANDSUBQ TISSUE, HIDRADENITIS, AXILL
EXCISION, SKIN AND SUBQ TISSUE, HIDRADENITIS, INGU
EXCISION, SKIN AND SUBQ TISSUE, HIDRADENITIS, INGU
EXCISION, SKIN AND SUBQ TISSUE, HIDRADENITIS, PERI
EXCISION, SKIN AND SUBQ TISSUE, HIDRADENITIS, PERI
DOC PT RSK DEATH W/IN 1YR
DOC NO PT RSK DEATH W/IN 1YR
DOC ADVNCD DIS COMFORT 1ST
DOC ADVNCD DIS CMFRT NOT 1ST
ADVNC CARE PLAN IN RCRD
1/1/2012
1/1/2012
1/1/2012
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2012
1/1/2007
1/1/2010
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
7/1/2011
7/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
1158F
1159F
11600
11601
11602
11603
11604
11606
1160F
11620
11621
11622
11623
11624
11626
11640
11641
11642
11643
11644
11646
1170F
11719
11720
11721
11730
11732
11740
11750
11752
11755
1175F
11760
11762
11765
11770
11771
11772
1180F
1181F
1182F
1183F
11900
11901
11920
11921
11922
11950
11951
11952
11954
11960
11970
11971
11976
11980
11981
11982
11983
12001
12002
12004
12005
12006
12007
1200F
12011
12013
12014
12015
12016
12017
12018
12020
12021
12031
12032
12034
12035
12036
12037
12041
12042
12044
12045
12046
12047
12051
12052
12053
12054
ADVNC CARE PLAN TLK DOCD
MED LIST DOCD IN RCRD
EXCISION, MALIGNANT LESION, INCL MARGINS, TRUNK/AR
EXCISION, MALIGNANT LESION, DIAMETER 0.6 TO 1.0 CM
EXCISION, MALIGNANT LESION, DIAMETER 1.1 TO 2.0 CM
EXCISION, MALIGNANT LESION, DIAMETER 2.1 TO 3.0 CM
EXCISION, MALIGNANT LESION, INCL MARGINS, TRUNK/AR
EXCISION, MALIGNANT LESION, INCL MARGINS, TRUNK/AR
RVW MEDS BY RX/DR IN RCRD
EXCISION, MALIGNANT LESION, INCL MARGINS, SCALP/NE
EXCISION, MALIGNANT LESION, INCL MARGINS, SCALP/NE
EXCISION, MALIGNANT LESION, INCL MARGINS, SCALP/NE
EXCISION, MALIGNANT LESION, INCL MARGINS, SCALP/NE
EXCISION, MALIGNANT LESION, INCL MARGINS, SCALP/NE
EXCISION, MALIGNANT LESION, INCL MARGINS, SCALP/NE
EXCISION, MALIGNANT LESION, INCL MARGINS, FACE/EAR
EXCISION, MALIGNANT LESION, DIAMETER 0.6 TO 1.0 CM
EXCISION, MALIGNANT LESION, DIAMETER 1.1 TO 2.0 CM
EXCISION, MALIGNANT LESION, DIAMETER 2.1 TO 3.0 CM
EXCISION, MALIGNANT LESION, INCL MARGINS, FACE/EAR
EXCISION, MALIGNANT LESION, INCL MARGINS, FACE/EAR
FXNL STATUS ASSESSED
TRIMMING, NONDYSTROPHIC NAILS, ANY NUMBER
DEBRIDEMENT, NAIL(S), ANY METHOD(S); 1-5
DEBRIDEMENT, NAIL(S), ANY METHOD(S); OVER 6
AVULSION, NAIL PLATE, PARTIAL/COMPLETE, SIMPLE; SI
AVULSION, NAIL PLATE, PARTIAL/COMPLETE, SIMPLE; AD
EVACUATION, SUBUNGUAL HEMATOMA
EXCISION, NAIL/NAIL MATRIX, PERMANENT REMOVAL
EXCISION, NAIL/NAIL MATRIX, PERMANENT REMOVAL; W/A
BX, NAIL UNIT (SEP PROC)
FUNCTIONAL STATUS DEMENTIA ASSESS RESULTS RVWD
REPAIR, NAIL BED
RECONSTRUCTION, NAIL BED W/GRAFT
WEDGE EXCISION, SKIN, NAIL FOLD
EXCISION, PILONIDAL CYST/SINUS; SIMPLE
EXCISION, PILONIDAL CYST/SINUS; EXTENSIVE
EXCISION, PILONIDAL CYST/SINUS; COMPLICATED
THROMBOEMB RISK FACTORS ASSESSED
NEUROPSYCHIATRIC SYMPTS ASSESSED RESULTS REVIEWD
NEUROPSYCHIATRIC SYMPTOMS NE OR MORE PRESENT
NEUROPSYCHIATRIC SYMPTOMS ABSENT
INJECTION, INTRALESIONAL; UP TO AND INCL 7 LESIONS
INJECTION, INTRALESIONAL; MORE THAN LESIONS
TATTOOING TO CORRECT COLOR DEFECTS; 6.0 SQ CM/LESS
TATTOOING TO CORRECT COLOR DEFECTS; 6.1-20.0 SQ CM
TATTOOING TO CORRECT COLOR DEFECTS; ADDL 20.0 SQ C
SUBQ INJECTION, FILLING MATL; 1 CC/OR LESS
SUBQ INJECTION, FILLING MATL; 1.1 TO 5.0 CC
SUBQ INJECTION, FILLING MATL; 5.1 TO 10.0 CC
SUBQ INJECTION, FILLING MATL; OVER 10.0 CC
INSERTION, TISSUE EXPANDER(S), OTHER THAN BREAST,
REPLACEMENT, TISSUE EXPANDER W/PERMANENT PROSTHESI
REMOVAL, TISSUE EXPANDER(S) W/O INSERTION, PROSTHE
REMOVAL, IMPLANTABLE CONTRACEPTIVE CAPSULES
IMPLANTATION, HORMONE PELLET, SUBCUTANEOUS
INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
REMOVAL W/REINSERTION, NON-BIODEGRADABLE DRUG DELI
SIMPLE REPAIR, SUPERFICIAL WOUNDS, SCALP/NECK/AXIL
SIMPLE REPAIR, SUPERFICIAL WOUNDS, SCALP/NECK/AXIL
SIMPLE REPAIR, SUPERFICIAL WOUNDS, SCALP/NECK/AXIL
SIMPLE REPAIR, SUPERFICIAL WOUNDS, SCALP/NECK/AXIL
SIMPLE REPAIR, SUPERFICIAL WOUNDS, SCALP/NECK/AXIL
SIMPLE REPAIR, SUPERFICIAL WOUNDS, SCALP/NECK/AXIL
SZR TYPES + CURRENT SZR FREQ DOCD
SIMPLE REPAIR, SUPERFICIAL WOUNDS, FACE/EARS/EYELI
SIMPLE REPAIR, SUPERFICIAL WOUNDS, FACE/EARS/EYELI
SIMPLE REPAIR, SUPERFICIAL WOUNDS, FACE/EARS/EYELI
SIMPLE REPAIR, SUPERFICIAL WOUNDS, FACE/EARS/EYELI
SIMPLE REPAIR, SUPERFICIAL WOUNDS, FACE/EARS/EYELI
SIMPLE REPAIR, SUPERFICIAL WOUNDS, FACE/EARS/EYELI
SIMPLE REPAIR, SUPERFICIAL WOUNDS, FACE/EARS/EYELI
TREATMENT, SUPERFICIAL WOUND DEHISCENCE; SIMPLE CL
TREATMENT, SUPERFICIAL WOUND DEHISCENCE; W/PACKING
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMI
LAYER CLOSURE OF WOUNDS,SCALP,ETC 2.6 CM TO 7.5 CM
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMI
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMI
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMI
LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRUNK/EXTREMI
LAYER CLOSURE, WOUNDS, NECK, HANDS, FEET AND/OR EX
LAYER CLOSURE, WOUNDS, NECK, HANDS, FEET AND/OR EX
LAYER CLOSURE, WOUNDS, NECK, HANDS, FEET AND/OR EX
LAYER CLOSURE, WOUNDS, NECK, HANDS, FEET AND/OR EX
LAYER CLOSURE, WOUNDS, NECK, HANDS, FEET AND/OR EX
LAYER CLOSURE, WOUNDS, NECK, HANDS, FEET AND/OR EX
LAYER CLOSURE, WOUNDS, FACE/EARS/EYELIDS/NOSE/LIPS
LAYER CLOSURE, WOUNDS, FACE/EARS/EYELIDS/NOSE/LIPS
LAYER CLOSURE, WOUNDS, FACE/EARS/EYELIDS/NOSE/LIPS
LAYER CLOSURE, WOUNDS, FACE/EARS/EYELIDS/NOSE/LIPS
1/1/2009
1/1/2009
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2008
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
N
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
12055
12056
12057
1205F
1220F
13100
13101
13102
13120
13121
13122
13131
13132
13133
13151
13152
13153
13160
14000
14001
1400F
14020
14021
14040
14041
14060
14061
14301
14302
14350
1450F
1451F
1460F
1461F
1490F
1491F
1493F
1494F
15002
15003
15004
15005
1500F
1501F
1502F
1503F
15040
1504F
15050
1505F
15100
15101
15110
15111
15115
15116
15120
15121
15130
15131
15135
15136
15150
15151
15152
15155
15156
15157
15200
15201
15220
15221
15240
15241
15260
15261
15271
15272
15273
15274
15275
15276
15277
15278
15570
15572
15574
15576
15600
15610
15620
LAYER CLOSURE, WOUNDS, FACE/EARS/EYELIDS/NOSE/LIPS
LAYER CLOSURE, WOUNDS, FACE/EARS/EYELIDS/NOSE/LIPS
LAYER CLOSURE, WOUNDS, FACE/EARS/EYELIDS/NOSE/LIPS
ETIOLOGY OF EPILEPSY SYNDROME(S) RVWD DOCD
PATIENT SCREENED FOR DEPRESSION
REPAIR, COMPLEX, TRUNK; 1.1 TO 2.5 CM
REPAIR, COMPLEX, TRUNK; 2.6 TO 7.5 CM
REPAIR, COMPLEX TRUNK, EACH ADDL 5 CM OR LESS
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 TO
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 TO
REPAIR, COMPLEX, SCALP, ETC EACH ADDL 5 CM OR LESS
REPAIR, COMPLEX, FOREHEAD/CHEEKS/CHIN/MOUTH/NECK/A
REPAIR, COMPLEX, FOREHEAD/CHEEKS/CHIN/MOUTH/NECK/A
REPAIR, COMPLEX, FOREHEAD, EACH ADDL 5 CM OR LESS
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS;
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS;
REPAIR, COMPLEX, EYELIDS, EACH ADDL 5 CM OR LESS
SECONDARY CLOSURE, SURGICAL WOUND/DEHISCENCE, EXTE
ADJACENT TISSUE TRANSFER/REARRANGEMENT, TRUNK; DEF
ADJACENT TISSUE TRANSFER/REARRANGEMENT, TRUNK; DEF
PRKNS DIAG RVIEWED
ADJACENT TISSUE TRANSFER/REARRANGEMENT, SCALP, ARM
ADJACENT TISSUE TRANSFER/REARRANGEMENT, SCALP, ARM
ADJACENT TISSUE TRANSFER, FOREHEAD/CHEEKS/CHIN/MOU
ADJACENT TISSUE TRANSFER, FOREHEAD/CHEEKS/CHIN/MOU
ADJACENT TISSUE TRANSFER/REARRANGEMENT, EYELIDS/NO
ADJACENT TISSUE TRANSFER/REARRANGEMENT, EYELIDS/NO
ATT/R ANY AREA DEFECT 30.1-60SQCM
ATT/R ANY AREA DEFECT EA ADDL 30SQCM OR PART
FILLETED FINGER/TOE FLAP, W/PREPARATION, RECIPIENT
SYMPTOMS IMPROVED/CONSIST W/TXMNT GOAL ASSESSMNT
SYMPTOMS SHOW CLIN IMPRTNT DROP SINCE ASSESSMENT
QUALIFYING CARD EVENT/DIAGNOSIS PRIOR 12 MONTHS
NO QUAL CARD EVENT/DIAG IN PREVIOUS 12 MONTHS
DEMENTIA SEVERITY CLASSIFIED MILD
DEMENTIA SEVERITY CLASSIFIED MODERATE (DEM)
DEMENTIA SEVERITY CLASSIFIED SEVERE
COGNITION ASSESSED AND REVIEWED
Wnd prep, ch/inf, trk/arm/lg
Wnd prep, ch/inf addl 100 cm
Wnd prep ch/inf, f/n/hf/g
Wnd prep, f/n/hf/g, addl cm
SYMP+SIGN DISTAL SYMM POLYNEUROPATHY REVWD+DOCD
NOT INITIAL EVALUATION FOR CONDITION
PT QUERIED RE PAIN W/FUNC USING RELIABLE INSTRM
PT QUERIED RE SYMP RESPIRATORY INSUFFICIENCY
HARVEST OF SKIN FOR TISSUE CULTURED SKIN, 100 CM O
PATIENT HAS RESPIRATORY INSUFFICIENCY
PINCH GRAFT, SINGLE/MULTIPLE, (EXCEPT ON FACE), 2
PATIENT DOES NOT HAVE RESPIRATORY INSUFFICIENCY
SPLIT GRAFT, TRUNK/EXTREMITIES; 1ST 100 SQ CM/LESS
SPLIT GRAFT, TRUNK/EXTREMITIES; ADDL 100 SQ CM/ 1P
EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS, FIRST 100
EPIDERMAL AUTOGRAFT, TRUNK, ARMS, LEGS, EACH ADD'L
EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH,
EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH,
SPLIT GRAFT, FACE/SCALP/MOUTH/HNDS/FEET/GENIT/MULT
SPLIT GRAFT, FACE/SCALP/MOUTH/HNDS/FEET/GENIT/MULT
DERMAL AUTOGRAFT, TRUNK , ARMS, LEGS, FIRST 100CM
DERMAL AUTOGRAFT, TRUNK , ARMS, LEGS, FIRST EACH A
DERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, FIR
DERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, EAC
CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/<
CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM
CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA
CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/<
CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM
CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT EA 100 EA
FULL THICKNESS GRAFT, FREE, W/DIRECT CLOSURE, DONO
FULL THICKNESS GRAFT, FREE, W/DIRECT CLOSURE, DONO
FULL THICKNESS GRAFT, FREE, W/CLOSURE DONOR SITE,
FULL THICKNESS GRAFT, FREE, W/CLOSURE DONOR SITE,
FULL THICKNESS GRAFT, FREE, W/CLOSURE DONOR, FACE/
FULL THICKNESS GRAFT, FREE, W/CLOSURE DONOR, FACE/
FULL THICKNESS GRAFT, FREE, W/CLOSURE DONOR SITE,
FULL THICKNESS GRAFT, FREE, W/CLOSURE DONOR SITE,
APP SKN SUB GRFT T/A/L AREA/<100SCM /<1ST 25 SCM
APP SKN SUB GRFT T/A/L AREA/<100SCM EA ADL 25SCM
APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM
APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM
SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM
SUB GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM
SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM
SUB GRFT F/S/N/H/F/G/M/D />100SCM ADL 100SCM
FORMATION, DIRECT/TUBED PEDICLE, W/WO TRANSFER; TR
FORMATION, DIRECT/TUBED PEDICLE, W/WO TRANSFER; SC
FORMATION, DIRECT/TUBED PEDICLE W/WO TRANSF; FACE/
FORMATION, DIRECT/TUBED PEDICLE, W/WO TRANSFER; EY
DELAY, FLAP/SECTIONING, FLAP (DIVISION AND INSET);
DELAY, FLAP/SECTIONING, FLAP (DIVISION AND INSET);
DELAY, FLAP/SECTIONING, FLAP (DIVISION AND INSET);
1/1/2004
1/1/2004
1/1/2004
1/1/2010
10/1/2008
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
10/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2006
1/1/2013
1/1/2004
1/1/2013
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
15630
15650
15731
15732
15734
15736
15738
15740
15750
15756
15757
15758
15760
15770
15775
15776
15777
15780
15781
15782
15783
15786
15787
15788
15789
15792
15793
15819
15820
15821
15822
15823
15824
15825
15826
15828
15829
15830
15832
15833
15834
15835
15836
15837
15838
15839
15840
15841
15842
15845
15847
15850
15851
15852
15860
15876
15877
15878
15879
15920
15922
15931
15933
15934
15935
15936
15937
15940
15941
15944
15945
15946
15950
15951
15952
15953
15956
15958
15999
16000
16020
16025
16030
16035
16036
17000
17003
17004
17106
17107
17108
DELAY, FLAP/SECTIONING, FLAP (DIVISION AND INSET);
TRANSFER, INTERMEDIATE, ANY PEDICLE FLAP, ANY LOCA
Forehead flap w/vasc pedicle
MUSCLE, MYOCUTANEOUS/FASCIOCUTANEOUS FLAP; HEAD AN
MUSCLE, MYOCUTANEOUS/FASCIOCUTANEOUS FLAP; TRUNK
MUSCLE, MYOCUTANEOUS/FASCIOCUTANEOUS FLAP; UPPER E
MUSCLE, MYOCUTANEOUS/FASCIOCUTANEOUS FLAP; LOWER E
FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY
FLAP; NEUROVASCULAR PEDICLE
FREE MUSCLE/MYOCUTANEOUS FLAP W/MICROVASCULAR ANAS
FREE SKIN FLAP W/MICROVASCULAR ANASTOMOSIS
FREE FASCIAL FLAP W/MICROVASCULAR ANASTOMOSIS
GRAFT; COMPOSITE, W/PRIMARY CLOSURE, DONOR AREA
GRAFT; DERMA-FAT-FASCIA
PUNCH GRAFT, HAIR TRANSPLANT; 1-15 PUNCH GRAFTS
PUNCH GRAFT, HAIR TRANSPLANT; OVER 15 PUNCH GRAFTS
IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT
DERMABRASION; TOTAL FACE
DERMABRASION; SEGMENTAL, FACE
DERMABRASION; REGIONAL, OTHER THAN FACE
DERMABRASION; SUPERFICIAL, ANY SITE
ABRASION; SINGLE LESION
ABRASION; ADDL 4 LESIONS/LESS
CHEMICAL PEEL, FACIAL; EPIDERMAL
CHEMICAL PEEL, FACIAL; DERMAL
CHEMICAL PEEL, NONFACIAL; EPIDERMAL
CHEMICAL PEEL, NONFACIAL; DERMAL
CERVICOPLASTY
BLEPHAROPLASTY, LOWER EYELID
BLEPHAROPLASTY, LOWER EYELID; W/EXTENSIVE HERNIATE
BLEPHAROPLASTY, UPPER EYELID
BLEPHAROPLASTY, UPPER EYELID; W/EXCESSIVE SKIN WEI
RHYTIDECTOMY; FOREHEAD
RHYTIDECTOMY; NECK W/PLATYSMAL TIGHTENING (PLATYSM
RHYTIDECTOMY; GLABELLAR FROWN LINES
RHYTIDECTOMY; CHEEK, CHIN, AND NECK
RHYTIDECTOMY; SUPERFICIAL MUSCULOAPONEUROTIC SYSTE
Exc skin abd
EXCISION, EXCESSIVE SKIN AND SUBQ TISSUE (W/LIPECT
EXCISION, EXCESSIVE SKIN AND SUBQ TISSUE (W/LIPECT
EXCISION, EXCESSIVE SKIN AND SUBQ TISSUE (W/LIPECT
EXCISION, EXCESSIVE SKIN AND SUBQ TISSUE (W/LIPECT
EXCISION, EXCESSIVE SKIN AND SUBQ TISSUE (W/LIPECT
EXCISION, EXCESSIVE SKIN AND SUBQ TISSUE (W/LIPECT
EXCISION, EXCESSIVE SKIN AND SUBQ TISSUE (W/LIPECT
EXCISION, EXCESSIVE SKIN AND SUBQ TISSUE (W/LIPECT
GRAFT, FACIAL NERVE PARALYSIS; FREE FASCIA GRAFT (
GRAFT, FACIAL NERVE PARALYSIS; FREE MUSCLE GRAFT (
GRAFT, FACIAL NERVE PARALYSIS; FREE MUSCLE FLAP, M
GRAFT, FACIAL NERVE PARALYSIS; REGIONAL MUSCLE TRA
Exc skin abd add-on
REMOVAL, SUTURES UNDER ANESTHESIA (OTHER THAN LOCA
REMOVAL OF SUTURES UNDER ANESTHESIA(OTHER THAN LOC
DRESSING CHANGE (FOR OTHER THAN BURNS) UNDER ANEST
IV INJECTION, AGENT TO TEST VASCULAR FLOW IN FLAP/
SUCTION ASSISTED LIPECTOMY; HEAD AND NECK
SUCTION ASSISTED LIPECTOMY; TRUNK
SUCTION ASSISTED LIPECTOMY; UPPER EXTREMITY
SUCTION ASSISTED LIPECTOMY; LOWER EXTREMITY
EXCISION, COCCYGEAL PRESSURE ULCER, W/COCCYGECTOMY
EXCISION, COCCYGEAL PRESSURE ULCER, W/COCCYGECTOMY
EXCISION, SACRAL PRESSURE ULCER, W/PRIMARY SUTURE;
EXCISION, SACRAL PRESSURE ULCER, W/PRIMARY SUTURE;
EXCISION, SACRAL PRESSURE ULCER, W/SKIN FLAP CLOSU
EXCISION, SACRAL PRESSURE ULCER, W/SKIN FLAP CLOSU
EXCISION, SACRAL PRESSURE ULCER, PREP, MUSCLE/MYOC
EXCISION, SACRAL PRESSURE ULCER, PREP, MUSCLE/MYOC
EXCISION, ISCHIAL PRESSURE ULCER, W/PRIMARY SUTURE
EXCISION, ISCHIAL PRESSURE ULCER, W/PRIMARY SUTURE
EXCISION, ISCHIAL PRESSURE ULCER, W/SKIN FLAP CLOS
EXCISION, ISCHIAL PRESSURE ULCER, W/SKIN FLAP CLOS
EXCISION, ISCHIAL PRESSURE ULCER, W/OSTECTOMY, PRE
EXCISION, TROCHANTERIC PRESSURE ULCER, W/PRIMARY S
EXCISION, TROCHANTERIC PRESSURE ULCER, W/PRIMARY S
EXCISION, TROCHANTERIC PRESSURE ULCER, W/SKIN FLAP
EXCISION, TROCHANTERIC PRESSURE ULCER, W/SKIN FLAP
EXCISION, TROCHANTERIC PRESSURE ULCER, PREP, MUSCL
EXCISION, TROCHANTERIC PRESSURE ULCER, PREP, MUSCL
UNLISTED PROC, EXCISION PRESSURE ULCER
INITIAL TREATMENT, 1ST DEGREE BURN, WHEN NO MORE T
DRESSINGS AND/OR DEBRIDEMENT, INITIAL/SUBSEQUENT;
DRESSINGS AND/OR DEBRIDEMENT, INITIAL/SUBSEQUENT;
DRESSINGS AND/OR DEBRIDEMENT, INITIAL/SUBSEQUENT;
ESCHAROTOMY; INITIAL INCISION
ESCHAROTOMY; ADDL INCISION
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN
DESTRUCTION, BENIGN/PREMALIG LESIONS, EXCEPT SKIN
DESTRUCTION, CUTANEOUS VASCULAR PROLIFERATIVE LESI
DESTRUCTION, CUTANEOUS VASCULAR PROLIFERATIVE LESI
DESTRUCTION, CUTANEOUS VASCULAR PROLIFERATIVE LESI
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
Y
N
N
N
N
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
17110
17111
17250
17260
17261
17262
17263
17264
17266
17270
17271
17272
17273
17274
17276
17280
17281
17282
17283
17284
17286
17311
17312
17313
17314
17315
17340
17360
17380
17999
19000
19001
19020
19030
19081
19082
19083
19084
19085
19086
19100
19101
19105
19110
19112
19120
19125
19126
19260
19271
19272
19281
19282
19283
19284
19285
19286
19287
19288
19296
19297
19298
19300
19301
19302
19303
19304
19305
19306
19307
19316
19318
19324
19325
19328
19330
19340
19342
19350
19355
19357
19361
19364
19366
19367
19368
19369
19370
19371
19380
19396
DESTRUCTION, FLAT WARTS, MOLLUSCUM CONTAGIOSUM/MIL
DESTRUCTION, FLAT WARTS, MOLLUSCUM CONTAGIOSUM/MIL
CHEMICAL CAUTERIZATION, GRANULATION TISSUE (PROUD
DESTRUCTION, MALIGNANT LESION, TRUNK/ARMS/LEGS; LE
DESTRUCTION, MALIGNANT LESION, TRUNK/ARMS/LEGS; LE
DESTRUCTION, MALIGNANT LESION, TRUNK/ARMS/LEGS; LE
DESTRUCTION, MALIGNANT LESION, TRUNK/ARMS/LEGS; LE
DESTRUCTION, MALIGNANT LESION, TRUNK/ARMS/LEGS; LE
DESTRUCTION, MALIGNANT LESION, TRUNK/ARMS/LEGS; LE
DESTRUCTION, MALIGNANT LESION, SCALP/NECK/HANDS/FE
DESTRUCTION, MALIGNANT LESION, SCALP/NECK/HANDS/FE
DESTRUCTION, MALIGNANT LESION, SCALP/NECK/HANDS/FE
DESTRUCTION, MALIGNANT LESION, SCALP/NECK/HANDS/FE
DESTRUCTION, MALIGNANT LESION, SCALP/NECK/HANDS/FE
DESTRUCTION, MALIGNANT LESION, SCALP/NECK/HANDS/FE
DESTRUCTION, MALIGNANT LESION, FACE/EARS/EYELIDS/N
DESTRUCTION, MALIGNANT LESION, FACE/EARS/EYELIDS/N
DESTRUCTION, MALIGNANT LESION, FACE/EARS/EYELIDS/N
DESTRUCTION, MALIGNANT LESION, FACE/EARS/EYELIDS/N
DESTRUCTION, MALIGNANT LESION, FACE/EARS/EYELIDS/N
DESTRUCTION, MALIGNANT LESION, FACE/EARS/EYELIDS/N
Mohs, 1 stage, h/n/hf/g
Mohs addl stage
Mohs, 1 stage, t/a/l
Mohs, addl stage, t/a/l
Mohs surg, addl block
CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR ACNE
CHEMICAL EXFOLIATION, ACNE
ELECTROLYSIS EPILATION, EACH ONE HALF HOUR
UNLISTED PROC, SKIN, MUCOUS MEMBRANE AND SUBQ TISS
PUNCTURE ASPIRATION, CYST, BREAST;
PUNCTURE ASPIRATION, CYST, BREAST; EACH ADDL CYST
MASTOTOMY W/EXPLORATION/DRAINAGE, ABSCESS, DEEP
INJECTION PROC ONLY, MAMMARY DUCTOGRAM/GALACTOGRAM
BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE
BX BREAST W DEVICE ADDL LESION STEREOTACT GUIDE
BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE
BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE
BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE
BX BREAST W DEVICE ADDL LESION MAGNET RES GUIDE
BX, BREAST; PERCUT, NEEDLE CORE, NOT USING IMAGING
BX, BREAST; OPEN INCISIONAL
Cryosurg ablate fa, each
NIPPLE EXPLORATION W/WO EXCISION SOLITARY/PAPILLOM
EXCISION, LACTIFEROUS DUCT FISTULA
EXCISION, BREAST LESION(S), OPEN, MALE/FEMALE; 1 O
EXCISION, BREAST LESION, PREOP PLACEMENT, RADIOLOG
EXCISION, BREAST LESION, PREOP PLACEMENT, RADIOLOG
EXCISION, CHEST WALL TUMOR W/RIBS
EXCISION, CHEST WALL TUMOR W/RIBS, W/RECONSTRUCT;
EXCISION, CHEST WALL TUMOR W/RIBS, W/RECONSTRUCT;
PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE
PERQ DEVICE PLACEMT BREAST LOC EA LES W GUIDNCE
PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GUID
PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID
PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID
PLACEMENT OF RADIOTHERAPY, FOLLOWING PARTIAL MASTE
PLACEMENT OF RADIOTHERAPY CONCURRENT W PARTIAL MAS
PLACEMENT OF RADIOTHERAPY, AT TIME OR SUBS TO PART
Removal of breast tissue
Partial mastectomy
P-mastectomy w/ln removal
Mast, simple, complete
Mast, subq
Mast, radical
Mast, rad, urban type
Mast, mod rad
MASTOPEXY
REDUCTION MAMMAPLASTY
MAMMAPLASTY, AUGMENTATION; W/O PROSTHETIC IMPLANT
MAMMAPLASTY, AUGMENTATION; W/PROSTHETIC IMPLANT
REMOVAL, INTACT MAMMARY IMPLANT
REMOVAL, MAMMARY IMPLANT MATL
IMMEDIATE INSERTION, BREAST PROSTHESIS FOLLOWING M
DELAYED INSERTION, BREAST PROSTHESIS FOLLOWING MAS
NIPPLE/AREOLA RECONSTRUCTION
CORRECTION, INVERTED NIPPLES
BREAST RECONSTRUCTION W/TISSUE EXPANDER, IMMEDIATE
BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP, W/W
BREAST RECONSTRUCTION W/FREE FLAP
BREAST RECONSTRUCTION W/OTHER TECHNIQUE
BREAST RECONSTRUCTION W/MYOCUTANEOUS (TRAM) FLAP,
BREAST RECONSTRUCTION W/MYOCUTAN (TRAM) FLAP, SING
BREAST RECONSTRUCTION W/MYOCUTANEOUS (TRAM) FLAP,
OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST
PERIPROSTHETIC CAPSULECTOMY, BREAST
REVISION, RECONSTRUCTED BREAST
PREPARATION, MOULAGE, CUSTOM BREAST IMPLANT
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
Y
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
19499
20005
2000F
20100
20101
20102
20103
2010F
2014F
20150
2015F
2016F
2018F
2019F
20200
20205
20206
2020F
2021F
20220
20225
2022F
20240
20245
2024F
20250
20251
2026F
2027F
2028F
2029F
2030F
2031F
2040F
2044F
20500
20501
2050F
20520
20525
20526
20527
20550
20551
20552
20553
20555
20600
20604
20605
20606
2060F
20610
20611
20612
20615
20650
20660
20661
20662
20663
20664
20665
20670
20680
20690
20692
20693
20694
20696
20697
20802
20805
20808
20816
20822
20824
20827
20838
20900
20902
20910
20912
20920
20922
20924
20926
20930
20931
20936
20937
UNLISTED PROC, BREAST
I&D SOFT TISSUE ABSCESS SUBFASC
BLOOD PRESSURE MEASURED
EXPLORATION, PENETRATING WOUND (SEP PROC); NECK
EXPLORATION, PENETRATING WOUND (SEP PROC); CHEST
EXPLORATION, PENETRATING WOUND (SEP PROC); ABDOMEN
EXPLORATION OF PENETRATING WOUND, EXTREMITY
Vital signs recorded
Mental status assess
EXCISION, EPIPHYSEAL BAR, W/WO AUTOGENOUS SOFT TIS
ASTHMA IMPAIRMENT ASSESSED
ASTHMA RISK ASSESSED
Hydration status assess
Dilated macul exam done
BX, MUSCLE; SUPERFICIAL
BX, MUSCLE; DEEP
BX, MUSCLE, PERCUTANEOUS NEEDLE
Dilated fundus eval done
Dilat macul+exam done
BX, BONE, TROCAR/NEEDLE; SUPERFICIAL
BX, BONE, TROCAR/NEEDLE; DEEP
Dil retina exam interp rev
BX, BONE, EXCISIONAL; SUPERFICIAL
BX, BONE, EXCISIONAL; DEEP
7 field photo interp doc rev
BX, VERTEBRAL BODY, OPEN; THORACIC
BX, VERTEBRAL BODY, OPEN; LUMBAR/CERVICAL
Eye image valid to dx rev
Optic nerve head eval done
Foot exam performed
Complete phys skin exam done
H2O stat documented, normal
H2O stat documented, dehydrated
PHYS EXAM ON DATE OF INIT VST FOR LBP DONE
DOC MNTL HLTH ASSESSB/4 INTRVN-BKSURG/EPID INJX
INJECTION, SINUS TRACT; THERAPEUTIC (SEP PROC)
INJECTION, SINUS TRACT; DX (SINOGRAM)
WOUND CHAR SIZE ETC DOCD
REMOVAL, FB IN MUSCLE/TENDON SHEATH; SIMPLE
REMOVAL, FB IN MUSCLE/TENDON SHEATH; DEEP/COMPLICA
INJECTION, THERAPEUTIC, CARPAL CANAL
INJECTION ENZYME PALMAR FASCIAL CORD
INJECTION(S); SINGLE TENDON SHEATH, LIGAMENT, APON
INJECTION(S); SINGLE TENDON ORIGIN/INSERTION
INJECTION(S); SINGLE/MULTIPLE TRIGGER POINT(S), 1INJECTION(S); SINGLE/MULTIPLE TRIGGER POINT(S), OV
PLACEMENT OF NEEDLES OR CATHETERS INTO MUSCLE AND/
ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
PT INTRVWD BY EVAL CLINICIAN </DATE DIAG MDD
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
ASPIRATION AND/OR INJECTION, GANGLION CYST(S) ANY
ASPIRATION AND INJECTION, TREATMENT, BONE CYST
INSERTION, WIRE/PIN W/APPLICATION, SKELETAL TRACTI
APPLICATION, CRANIAL TONGS, CALIPER/STEREOTACTIC F
APPLICATION, HALO, W/REMOVAL; CRANIAL
APPLICATION, HALO, W/REMOVAL; PELVIC
APPLICATION, HALO, W/REMOVAL; FEMORAL
APPL HALO 6/> PINS THIN SKULL OSTEOLOGY
REMOVAL TONG/HALO APPLIED BY ANOTHER INDIVIDUAL
REMOVAL, IMPLANT; SUPERFICIAL (SEP PROC)
REMOVAL, IMPLANT; DEEP
APPLICATION, UNIPLANE (PINS/WIRES IN ONE PLANE), U
APPLICATION, MULTIPLANE, UNILAT, EXT FIXATION SYST
ADJUSTMENT/REVISION, EXT FIXATION SYSTEM W/ANESTHE
REMOVAL, UNDER ANESTHESIA, EXT FIXATION SYSTEM
XTRNL FIXJ W/STEREOTACTIC ADJUSTMENT 1ST&SUBQ
XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT
REPLANTATION, ARM (INCLUDES SURGICAL NECK, HUMERUS
REPLANTATION, FOREARM (INCLUDES RADIUS AND ULNA TO
REPLANTATION, HAND (INCLUDES HAND THROUGH METACARP
REPLANTATION, DIGIT, W/O THUMB, (INC METACARPOPHAL
REPLANTATION, DIGIT, W/O THUMB, (DISTAL TIP TO SUB
REPLANTATION, THUMB (INCLUDES CARPOMETACARPAL JOIN
REPLANTATION, THUMB (INCLUDES DISTAL TIP TO MP JOI
REPLANTATION, FOOT, COMPLETE AMPUTATION
BONE GRAFT, ANY DONOR AREA; MINOR/SMALL
BONE GRAFT, ANY DONOR AREA; MAJOR/LARGE
CARTILAGE GRAFT; COSTOCHONDRAL
CARTILAGE GRAFT; NASAL SEPTUM
FASCIA LATA GRAFT; STRIPPER
FASCIA LATA GRAFT; INCISION AND AREA EXPOSURE, COM
TENDON GRAFT, FROM A DISTANCE
TISSUE GRAFTS, OTHER
ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED
ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL
AUTOGRAFT, SPINE SURGERY ONLY; LOCAL, SAME INCISIO
AUTOGRAFT, SPINE SURGERY ONLY; MORSELIZED, SEP INC
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2012
1/1/2012
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2015
1/1/2004
1/1/2015
1/1/2010
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
20938
20950
20955
20956
20957
20962
20969
20970
20972
20973
20974
20975
20979
20982
20983
20985
20999
21010
21011
21012
21013
21014
21015
21016
21025
21026
21029
21030
21031
21032
21034
21040
21044
21045
21046
21047
21048
21049
21050
21060
21070
21073
21076
21077
21079
21080
21081
21082
21083
21084
21085
21086
21087
21088
21089
21100
21110
21116
21120
21121
21122
21123
21125
21127
21137
21138
21139
21141
21142
21143
21145
21146
21147
21150
21151
21154
21155
21159
21160
21172
21175
21179
21180
21181
21182
21183
21184
21188
21193
21194
21195
AUTOGRAFT, SPINE SURGERY ONLY; STRUCTURAL/BICORTIC
MONITORING, INTERSTITIAL FLUID PRESSURE W/DEVICE I
BONE GRAFT W/MICROVASCULAR ANASTOMOSIS; FIBULA
BONE GRAFT W/MICROVASCULAR ANASTOMOSIS; ILIAC CRES
BONE GRAFT W/MICROVASCULAR ANASTOMOSIS; METATARSAL
BONE GRAFT W/MICROVASCULAR ANASTOMOSIS; OTHER THAN
FREE OSTEOCUTANEOUS FLAP W/MICROVASC ANASTOMOSIS;
FREE OSTEOCUTANEOUS FLAP W/MICROVASCULAR ANASTOMOS
FREE OSTEOCUTANEOUS FLAP W/MICROVASCULAR ANASTOMOS
FREE OSTEOCUTANEOUS FLAP W/MICROVASCULAR ANASTOMOS
ELECTRICAL STIMULATION TO AID BONE HEALING; NONINV
ELECTRICAL STIMULATION TO AID BONE HEALING; INVASI
LOW INTENSITY ULTRASOUND STIMULATION TO AID BONE H
ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE
ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD
COMPUTER-ASSISTED SURGICAL NAVIGATIONAL PROCEDURE
UNLISTED PROC, MUSCULOSKELETAL SYSTEM, GENERAL
ARTHROTOMY, TEMPOROMANDIBULAR JOINT
EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ < 2CM
EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2+CM
EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL < 2CM
EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2+CM
RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM
RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/>
EXCISION, BONE; MANDIBLE
EXCISION, BONE; FACIAL BONE(S)
REMOVAL BY CONTOURING, BENIGN TUMOR, FACIAL BONE
EXCISION, BENIGN TUMOR/CYST MAXILLA/ZYGOMA, ENUCLE
EXCISION, TORUS MANDIBULARIS
EXCISION, MAXILLARY TORUS PALATINUS
EXCISION, MALIGNANT TUMOR, MAXILLA/ZYGOMA
EXCISION, BENIGN TUMOR/CYST, MANDIBLE; ENUCLEATION
EXCISION, MALIGNANT TUMOR, MANDIBLE
EXCISION, MALIGNANT TUMOR, MANDIBLE; RADICAL RESEC
EXCISION, BENIGN TUMOR/CYST, MANDIBLE; INTRA-ORAL
EXCISION, BENIGN TUMOR/CYST, MANDIBLE; EXTRA-ORAL
EXCISION, BENIGN TUMOR/CYST, MAXILLA; INTRA-ORAL O
EXCISION, BENIGN TUMOR/CYST, MAXILLA; EXTRA-ORAL O
CONDYLECTOMY, TEMPOROMANDIBULAR JOINT (SEP PROC)
MENISCECTOMY, PARTIAL/COMPLETE, TEMPOROMANDIBULAR
CORONOIDECTOMY (SEP PROC)
MANIPULATION OF TEMPOROMANDIBULAR JOINT(S), THERAP
IMPRESSION AND CUSTOM PREPARATION; SURGICAL OBTURA
IMPRESSION AND CUSTOM PREPARATION; ORBITAL PROSTHE
IMPRESSION AND CUSTOM PREPARATION; INTERIM OBTURAT
IMPRESSION AND CUSTOM PREPARATION; DEFINITIVE OBTU
IMPRESSION AND CUSTOM PREPARATION; MANDIBULAR RESE
IMPRESSION AND CUSTOM PREPARATION; PALATAL AUGMENT
IMPRESSION AND CUSTOM PREPARATION; PALATAL LIFT PR
IMPRESSION AND CUSTOM PREPARATION; SPEECH AID PROS
IMPRESSION AND CUSTOM PREPARATION; ORAL SURGICAL S
IMPRESSION AND CUSTOM PREPARATION; AURICULAR PROST
IMPRESSION AND CUSTOM PREPARATION; NASAL PROSTHESI
IMPRESSION AND CUSTOM PREPARATION; FACIAL PROSTHES
UNLISTED MAXILLOFACIAL PROSTHETIC PROC
APPLICATION, HALO TYPE APPLIANCE, MAXILLOFACIAL FI
APPLICATION, INTERDENTAL FIXATION DEVICE, NON-FX/D
INJECTION PROC, TEMPOROMANDIBULAR JOINT ARTHROGRAP
GENIOPLASTY; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, P
GENIOPLASTY; SLIDING OSTEOTOMY, SINGLE PIECE
GENIOPLASTY; SLIDING OSTEOTOMIES, OVER 2 OSTEOTOMI
GENIOPLASTY; SLIDING, AUGMENTATION W/INTERPOSITION
AUGMENTATION, MANDIBULAR BODY/ANGLE; PROSTHETIC MA
AUGMENTATION, MANDIBULAR BODY/ANGLE; W/BONE GRAFT/
REDUCTION FOREHEAD; CONTOURING ONLY
REDUCTION FOREHEAD; CONTOURING/PROSTHESIS/BONE GRA
REDUCTION FOREHEAD; CONTOURING AND SETBACK, ANTERI
RECONSTRUCTION MIDFACE, LEFORT I; 1 PIECE, W/O BON
RECONSTRUCTION MIDFACE, LEFORT I; 2 PIECES, W/O BO
RECONSTRUCTION MIDFACE, LEFORT I; OVER 3 PIECES, W
RECONSTRUCTION MIDFACE, LEFORT I; 1 PIECE, W/BONE
RECONSTRUCTION MIDFACE, LEFORT I; 2 PIECES, W/BONE
RECONSTRUCTION MIDFACE, LEFORT I; OVER 3 PIECES, W
RECONSTRUCTION MIDFACE, LEFORT II; ANTERIOR INTRUS
RECONSTRUCTION MIDFACE, LEFORT II; W/BONE GRAFTS
RECONSTRUCTION MIDFACE, LEFORT III, W/BONE GRAFTS;
RECONSTRUCTION MIDFACE, LEFORT III, W/BONE GRAFTS;
RECONSTRUCTION MIDFACE, LEFORT III, (EXTRA/INTRACR
RECONSTRUCTION MIDFACE, LEFORT III, (EXTRA/INTRACR
RECONSTRUCTION SUPERIOR-LATERAL ORBITAL RIM AND LO
RECONSTRUCTION, BIFRONTAL,SUPERIOR-LATERAL ORBITAL
RECONSTRUCTION, MAJORITY, FOREHEAD AND SUPRAORBITA
RECONSTRUCTION, MAJORITY, FOREHEAD AND SUPRAORBITA
RECONSTRUCTION, CONTOURING, BENIGN TUMOR, CRANIAL
RECONSTRUCTION, ORBIT/FOREHEAD/NASOETHMOID, FOLLOW
RECONSTRUCTION, ORBIT/FOREHEAD/NASOETHMIOD, FOLLOW
RECONSTRUCTION, ORBIT/FOREHEAD/NASOETHMOID, FOLLOW
RECONSTRUCTION, MIDFACE, OSTEOTOMIES (NON-LEFORT T
RECONSTRUCTION, MANDIBULAR RAMI, HORIZONTAL, VERTI
RECONSTRUCTION, MANDIBULAR RAMI, HORIZONTAL, VERTI
RECONSTRUCTION, MANDIBULAR RAMI AND/OR BODY, SAGIT
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2008
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2010
1/1/2010
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
21196
21198
21199
21206
21208
21209
21210
21215
21230
21235
21240
21242
21243
21244
21245
21246
21247
21248
21249
21255
21256
21260
21261
21263
21267
21268
21270
21275
21280
21282
21295
21296
21299
21310
21315
21320
21325
21330
21335
21336
21337
21338
21339
21340
21343
21344
21345
21346
21347
21348
21355
21356
21360
21365
21366
21385
21386
21387
21390
21395
21400
21401
21406
21407
21408
21421
21422
21423
21431
21432
21433
21435
21436
21440
21445
21450
21451
21452
21453
21454
21461
21462
21465
21470
21480
21485
21490
21495
21497
21499
21501
RECONSTRUCTION, MANDIBULAR RAMI AND/OR BODY, SAGIT
OSTEOTOMY, MANDIBLE, SEGMENTAL
OSTEOTOMY, MANDIBLE, SEGMENTAL; W/GENIOGLOSSUS ADV
OSTEOTOMY, MAXILLA, SEGMENTAL
OSTEOPLASTY, FACIAL BONES; AUGMENTATION (AUTOGRAFT
OSTEOPLASTY, FACIAL BONES; REDUCTION
GRAFT, BONE; NASAL, MAXILLARY/MALAR AREAS (INCLUDE
GRAFT, BONE; MANDIBLE (INCLUDES OBTAINING GRAFT)
GRAFT; RIB CARTILAGE, AUTOGENOUS, FACE/CHIN/NOSE/E
GRAFT; EAR CARTILAGE, AUTOGENOUS, NOSE/EAR (INCLUD
ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, W/WO AUTOGR
ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, W/ALLOGRAFT
ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, W/PROSTHETI
RECONSTRUCTION, MANDIBLE, EXTRAORAL, W/TRANSOSTEAL
RECONSTRUCTION, MANDIBLE/MAXILLA, SUBPERIOSTEAL IM
RECONSTRUCTION, MANDIBLE/MAXILLA, SUBPERIOSTEAL IM
RECONSTRUCTION, MANDIBULAR CONDYLE W/BONE AND CART
RECONSTRUCTION, MANDIBLE/MAXILLA, ENDOSTEAL IMPLAN
RECONSTRUCTION, MANDIBLE/MAXILLA, ENDOSTEAL IMPLAN
RECONSTRUCTION, ZYGOMATIC ARCH/GLENOID FOSSA W/BON
RECONSTRUCTION, ORBIT W/OSTEOTOMIES AND BONE GRAFT
PERIORBITAL OSTEOTOMIES, ORBITAL HYPERTELORISM, W/
PERIORBITAL OSTEOTOMIES, ORBITAL HYPERTELORISM, W/
PERIORBITAL OSTEOTOMIES, ORBITAL HYPERTELORISM, W/
ORBITAL REPOSITIONING, PERIORBITAL OSTEOTOMIES, UN
ORBITAL REPOSITIONING, PERIORBITAL OSTEOTOMIES, UN
MALAR AUGMENTATION, PROSTHETIC MATL
SECONDARY REVISION, ORBITOCRANIOFACIAL RECONSTRUCT
MEDIAL CANTHOPEXY (SEP PROC)
LATERAL CANTHOPEXY
REDUCTION, MASSETER MUSCLE/BONE; EXTRAORAL APPROAC
REDUCTION, MASSETER MUSCLE/BONE; INTRAORAL APPROAC
UNLISTED CRANIOFACIAL AND MAXILLOFACIAL PROC
CLOSED TREATMENT, NASAL BONE FX W/O MANIPULATION
CLOSED TREATMENT, NASAL BONE FX; W/O STABILIZATION
CLOSED TREATMENT, NASAL BONE FX; W/STABILIZATION
OPEN TREATMENT, NASAL FX; UNCOMPLICATED
OPEN TREATMENT, NASAL FX; COMPLICATED, W/INT AND/O
OPEN TREATMENT, NASAL FX; W/CONCOMITANT OPEN TREAT
OPEN TREATMENT, NASAL SEPTAL FX, W/WO STABILIZATIO
CLOSED TREATMENT, NASAL SEPTAL FX, W/WO STABILIZAT
OPEN TREATMENT, NASOETHMOID FX; W/O EXT FIXATION
OPEN TREATMENT, NASOETHMOID FX; W/EXT FIXATION
PERCUT TREATMENT, NASOETHMOID COMPLEX FX, W SPLINT
OPEN TREATMENT, DEPRESSED FRONTAL SINUS FX
OPEN TREATMENT, COMPLICATED FRONTAL SINUS FX
CLOSED TREATMENT, NASOMAXILLARY COMPLEX FX (LEFORT
OPEN TREATMENT, NASOMAXILLARY COMPLEX FX (LEFORT I
OPEN TREATMENT, NASOMAXILLARY COMPLEX FX (LEFORT I
OPEN TREATMENT, NASOMAXILLARY COMPLEX FX (LEFORT I
PERCUT TREATMENT, FX, MALAR AREA, W/ZYGOMATIC ARCH
OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH FRACTUR
OPEN TREATMENT, DEPRESSED MALAR FX, W/ZYGOMATIC AR
OPEN TREATMENT, COMPLICATED FX, MALAR AREA, W/ZYGO
OPEN TREATMENT, COMPLICATED FX, MALAR AREA, W/ZYGO
OPEN TREATMENT, ORBITAL FLOOR BLOWOUT FX; TRANSANT
OPEN TREATMENT, ORBITAL FLOOR BLOWOUT FX; PERIORBI
OPEN TREATMENT, ORBITAL FLOOR BLOWOUT FX; COMBINED
OPEN TREATMENT, ORBITAL FLOOR BLOWOUT FX; PERIORBI
OPEN TREATMENT, ORBITAL FLOOR BLOWOUT FX; PERIORBI
CLOSED TREATMENT, FX, ORBIT, EXCEPT BLOWOUT; W/O M
CLOSED TREATMENT, FX, ORBIT, EXCEPT BLOWOUT; W/MAN
OPEN TREATMENT, FX, ORBIT, EXCEPT BLOWOUT; W/O IMP
OPEN TREATMENT, FX, ORBIT, EXCEPT BLOWOUT; W/IMPLA
OPEN TREATMENT, FX, ORBIT, EXCEPT BLOWOUT; W/BONE
CLOSED TREATMENT, PALATAL/MAXILLARY FX (LEFORT I T
OPEN TREATMENT, PALATAL/MAXILLARY FX (LEFORT I TYP
OPEN TREATMENT, PALATAL/MAXILLARY FX (LEFORT I TYP
CLOSED TREATMENT, CRANIOFACIAL SEPARATION (LEFORT
OPEN TREATMENT, CRANIOFACIAL SEPARATION (LEFORT II
OPEN TREATMENT, CRANIOFACIAL SEPARATION (LEFORT II
OPEN TREATMENT, CRANIOFACIAL SEPARATION (LEFORT II
OPEN TREATMENT, CRANIOFACIAL SEPARATION (LEFORT II
CLOSED TREATMENT, MANDIBULAR/MAXILLARY ALVEOLAR RI
OPEN TREATMENT, MANDIBULAR/MAXILLARY ALVEOLAR RIDG
CLOSED TREATMENT, MANDIBULAR FX; W/O MANIPULATION
CLOSED TREATMENT, MANDIBULAR FX; W/MANIPULATION
PERCUTANEOUS TREATMENT, MANDIBULAR FX, W/EXT FIXAT
CLOSED TREATMENT, MANDIBULAR FX W/INTERDENTAL FIXA
OPEN TREATMENT, MANDIBULAR FX W/EXT FIXATION
OPEN TREATMENT, MANDIBULAR FX; W/O INTERDENTAL FIX
OPEN TREATMENT, MANDIBULAR FX; W/INTERDENTAL FIXAT
OPEN TREATMENT, MANDIBULAR CONDYLAR FX
OPEN TREATMENT, MANDIBULAR FX, COMPLICATED, MULTIP
CLOSED TREATMENT, TEMPOROMANDIBULAR DISLOCATION; I
CLOSED TREATMENT, TEMPOROMANDIBULAR DISLOCATION; C
OPEN TREATMENT, TEMPOROMANDIBULAR DISLOCATION
OPEN TREATMENT, HYOID FX
INTERDENTAL WIRING, CONDITION OTHER THAN FX
UNLISTED MUSCULOSKELETAL PROC, HEAD
INCISION AND DRAINAGE, DEEP ABSCESS/HEMATOMA, SOFT
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
21502
21510
21550
21552
21554
21555
21556
21557
21558
21600
21610
21615
21616
21620
21627
21630
21632
21685
21700
21705
21720
21725
21740
21742
21743
21750
21805
21811
21812
21813
21820
21825
21899
21920
21925
21930
21931
21932
21933
21935
21936
22010
22015
22100
22101
22102
22103
22110
22112
22114
22116
22206
22207
22208
22210
22212
22214
22216
22220
22222
22224
22226
22305
22310
22315
22318
22319
22325
22326
22327
22328
22505
22510
22511
22512
22513
22514
22515
22526
22527
22532
22533
22534
22548
22551
22552
22554
22556
22558
22585
22586
INCISION AND DRAINAGE, DEEP ABSCESS/HEMATOMA, SOFT
INCISION, DEEP, W/OPENING, BONE CORTEX, THORAX
BX, SOFT TISSUE, NECK/THORAX
EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ 3+CM
EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5+CM
EXCISION TUMOR, SOFT TISSUE, NECK/THORAX; SUBQ
EXCISION TUMOR, SOFT TISSUE, NECK/THORAX; SUBFASC
RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM
RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>
EXCISION, RIB, PARTIAL
COSTOTRANSVERSECTOMY (SEP PROC)
EXCISION 1ST AND/OR CERVICAL RIB
EXCISION 1ST AND/OR CERVICAL RIB; W/SYMPATHECTOMY
OSTECTOMY, STERNUM, PARTIAL
STERNAL DEBRIDEMENT
RADICAL RESECTION, STERNUM;
RADICAL RESECTION, STERNUM; W/MEDIASTINAL LYMPHADE
HYOID MYOTOMY AND SUSPENSION
DIVISION, SCALENUS ANTICUS; W/O RESECTION, CERVICA
DIVISION, SCALENUS ANTICUS; W/RESECTION, CERVICAL
DIVISION, STERNOCLEIDOMASTOID, TORTICOLLIS, OPEN O
DIVISION, STERNOCLEIDOMASTOID, TORTICOLLIS, OPEN O
RECONSTRUCTIVE REPAIR, PECTUS EXCAVATUM/CARINATUM;
RECONSTRUCTIVE REPAIR, PECTUS EXCAVATUM/CARINATUM;
RECONSTRUCTIVE REPAIR, PECTUS EXCAVATUM/CARINATUM;
CLOSURE, MEDIAN STERNOTOMY SEPARATION, W/WO DEBRID
OPEN TREATMENT, RIB FX W/O FIXATION, EACH
OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS
OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS
OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS
CLOSED TREATMENT, STERNUM FX
OPEN TREATMENT, STERNUM FX W/WO SKELETAL FIXATION
UNLISTED PROC, NECK/THORAX
BX, SOFT TISSUE, BACK/FLANK; SUPERFICIAL
BX, SOFT TISSUE, BACK/FLANK; DEEP
EXC, TUMOR, SOFT TISSUE, BACK/FLANK SUBQ
EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ 3+CM
EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM
EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5+CM
RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM
RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>
I & D; OPEN OF DEEP ABSCESS; POSTERIOR SPINE; CERV
I & D; OPEN OF DEEP ABSCESS; POSTERIOR SPINE; LUMB
PARTIAL EXCISION, POSTERIOR VERTEBRAL COMPONENT, I
PARTIAL EXCISION, POSTERIOR VERTEBRAL COMPONENT, I
PARTIAL EXCISION, POSTERIOR VERTEBRAL COMPONENT, I
PARTIAL EXCISION, POST VERTEBRAL COMPONENT, INTRIN
PART EXCIS, VERTEBRAL BODY, BONY LESION, W/O SPINA
PART EXCIS, VERTEBRAL BODY, BONY LESION, W/O SPINA
PART EXCIS, VERTEBRAL BODY, BONY LESION, W/O SPINA
PART EXCIS, VERTEBRAL BODY, BONY LESION, W/O SPINA
OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL AP
OSTEOTOMY OF SPINE, LUMBAR
EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY
OSTEOTOMY, SPINE, POSTERIOR/POSTEROLATERAL APPROAC
OSTEOTOMY, SPINE, POSTERIOR/POSTEROLATERAL APPROAC
OSTEOTOMY, SPINE, POSTERIOR/POSTEROLATERAL APPROAC
OSTEOTOMY, SPINE, POSTERIOR/POSTEROLATERAL APPROAC
OSTEOTOMY, SPINE, W/DISKECTOMY, ANTERIOR APPROACH,
OSTEOTOMY, SPINE, W/DISKECTOMY, ANTERIOR APPROACH,
OSTEOTOMY, SPINE, W/DISKECTOMY, ANTERIOR APPROACH,
OSTEOTOMY, SPINE, W/DISKECTOMY, ANTERIOR APPROACH,
CLOSED TREATMENT, VERTEBRAL PROCESS FX(S)
CLOSED TREATMENT, VERTEBRAL BODY FX(S), W/O MANIPU
CLTX VRT FX&/DISLC CSTING/BRACING MNPJ/TRCJ
OPEN TREAT AND/OR REDUCTION, ODONTOID FX(S) AND/OR
OPEN TREAT AND/OR REDUCTION, ODONTOID FX(S) AND/OR
OPEN TREAT AND/OR REDUCT, VERTBR FX(S) AND/OR DISL
OPEN TREAT AND/OR REDUCT, VERTBR FX(S) AND/OR DISL
OPEN TREAT AND/OR REDUCT, VERTBR FX(S) AND/OR DISL
OPEN TREAT AND/OR REDUCT, VERTBR FX(S) AND/OR DISL
MANIPULATION, SPINE, REQUIRING ANESTHESIA, ANY REG
PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC
PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL
VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL
PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION
PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR
PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH
Idet, single level
Idet, 1 or more levels
LAT EXTRACAVITARY ARTHRODESIS, W/MIN DISKECTOMY; T
LAT EXTRACAVITARY ARTHRODESIS, W/MIN DISKECTOMY; L
LAT EXTRACAVITARY ARTHRODESIS, W/MIN DISKECTOMY; T
ARTHRODESIS, ANTERIOR TRANSORAL/EXTRAORAL, ATLAS-A
ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
ARTHRODESIS, ANTERIOR INTERBODY, W/MININMAL DISKEC
ARTHRODESIS, ANTERIOR INTERBODY, W/MININMAL DISKEC
ARTHRODESIS, ANTERIOR INTERBODY, W/MININMAL DISKEC
ARTHRODESIS, ANTERIOR INTERBODY, W/MININMAL DISKEC
ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L5/S1
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2010
1/1/2004
1/1/2010
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
22590
22595
22600
22610
22612
22614
22630
22632
22633
22634
22800
22802
22804
22808
22810
22812
22818
22819
22830
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849
22850
22851
22852
22855
22856
22857
22858
22861
22862
22864
22865
22899
22900
22901
22902
22903
22904
22905
22999
23000
23020
23030
23031
23035
23040
23044
23065
23066
23071
23073
23075
23076
23077
23078
23100
23101
23105
23106
23107
23120
23125
23130
23140
23145
23146
23150
23155
23156
23170
23172
23174
23180
23182
23184
23190
23195
23200
23210
23220
23330
23332
23333
ARTHRODESIS, POSTERIOR TECHNIQUE, CRANIOCERVICAL
ARTHRODESIS, POSTERIOR TECHNIQUE, ATLAS-AXIS
ARTHRODESIS, POSTERIOR/POSTEROLATERAL TECHNIQUE, S
ARTHRODESIS POSTERIOR/POSTEROLATERAL THORACIC
ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR
ARTHRODESIS, POSTERIOR/POSTEROLATERAL TECHNIQUE, S
ARTHRODESIS, POST INTERBODY W/LAMINECTOMY AND/OR D
ARTHRODESIS, POST INTERBODY W/LAMINECT AND/OR DISK
ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR
ARTHDSIS POST/POSTERLATRL/POSTINTRBDYADL SPC/SEG
ARTHRODESIS, POSTERIOR, SPINAL DEFORMITY, W/WO CAS
ARTHRODESIS, POSTERIOR, SPINAL DEFORMITY, W/WO CAS
ARTHRODESIS, POSTERIOR, SPINAL DEFORMITY, W/WO CAS
ARTHRODESIS, ANTERIOR, SPINAL DEFORMITY, W/WO CAST
ARTHRODESIS, ANTERIOR, SPINAL DEFORMITY, W/WO CAST
ARTHRODESIS, ANTERIOR, SPINAL DEFORMITY, W/WO CAST
KYPHECTOMY, CIRCUMFERENTIAL EXPOSURE, SPINE; 1-2 V
KYPHECTOMY, CIRCUMFERENTIAL EXPOSURE, SPINE; OVER
EXPLORATION, SPINAL FUSION
POST NON-SEGMENTAL INSTRUMENTATION
INT SPINAL FIXATION, WIRING, SPINOUS PROCESSES
POSTERIOR SEGMENTAL INSTRUMENTATION; 3-6 VERTEBRAL
POSTERIOR SEGMENTAL INSTRUMENTATION; 7-12 VERTEBRA
POSTERIOR SEGMENTAL INSTRUMENTATION; OVER 13 VERTE
ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENT
ANTERIOR INSTRUMENTATION; 4 TO 7 VERTEBRAL SEGMENT
ANTERIOR INSTRUMENTATION;OVER 8 VERTEBRAL SEGMENT
PELVIC FIXATION, NON-SACRUM
REINSERTION, SPINAL FIXATION DEVICE
REMOVAL, POSTERIOR NONSEGMENTAL INSTRUMENTATION
APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE
REMOVAL, POSTERIOR SEGMENTAL INSTRUMENTATION
REMOVAL, ANTERIOR INSTRUMENTATION
TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV
Lumbar artif diskectomy
TOT DISC ARTHRP ANT APPR DISC 2ND LEVEL CERVICAL
REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC CRV
Revise lumbar artif disc
RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE CERVICAL
Remove lumb artif disc
UNLISTED PROC, SPINE
EXCISION, ABDOMINAL WALL TUMOR, SUBFASCIAL
EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM
EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM
EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM
RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM
RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/>
UNLISTED PROC, ABDOMEN, MUSCULOSKELETAL SYSTEM
REMOVAL, SUBDELTOID CALCAREOUS DEPOSITS, OPEN
CAPSULAR CONTRACTURE RELEASE
INCISION AND DRAINAGE, SHOULDER AREA; DEEP ABSCESS
INCISION AND DRAINAGE, SHOULDER AREA; INFECTED BUR
INCISION, BONE CORTEX, SHOULDER AREA
ARTHROTOMY, GLENOHUMERAL JOINT, W/EXPLORATION, DRA
ARTHROTOMY, ACROMIOCLAVICULAR, STERNOCLAVICULAR JN
BX, SOFT TISSUE, SHOULDER AREA; SUPERFICIAL
BX, SOFT TISSUE, SHOULDER AREA; DEEP
EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3+CM
EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5+CM
EXCISION, SOFT TISSUE TUMOR, SHOULDER AREA; SUBQ
EXCISION, SOFT TISSUE TUMOR, SHOULDER AREA; SUBFA
RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM
RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/>
ARTHROTOMY, GLENOHUMERAL JOINT, W/BX
ARTHROTOMY, ACROMIO/STERNOCLAVICULAR JOINT, W/BX A
ARTHROTOMY; GLENOHUMERAL JOINT, W/SYNOVECTOMY, W/W
ARTHROTOMY; STERNOCLAVICULAR JOINT, W/SYNOVECTOMY,
ARTHROTOMY, GLENOHUMERAL JOINT, W/EXPLORATION, W/W
CLAVICULECTOMY; PARTIAL
CLAVICULECTOMY; TOTAL
ACROMIOPLASTY/ACROMIONECTOMY, PARTIAL, W/WO CORACO
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, CLAVIC
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, CLAVIC
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, CLAVIC
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, PROXIM
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, PROXIM
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, PROXIM
SEQUESTRECTOMY, CLAVICLE
SEQUESTRECTOMY, SCAPULA
SEQUESTRECTOMY, HUMERAL HEAD TO SURGICAL NECK
PARTIAL EXCISION, BONE, CLAVICLE
PARTIAL EXCISION, BONE, SCAPULA
PARTIAL EXCISION, BONE, PROXIMAL HUMERUS
OSTECTOMY, SCAPULA, PARTIAL
RESECTION, HUMERAL HEAD
RADICAL RESECTION, TUMOR; CLAVICLE
RADICAL RESECTION, TUMOR; SCAPULA
RADICAL RESECTION, BONE TUMOR, PROXIMAL HUMERUS
REMOVAL, FB, SHOULDER; SUBQ
REMOVAL, FB, SHOULDER; COMPLICATED
REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM
1/1/2004
1/1/2004
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1/1/2004
1/1/2014
12/31/9999
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12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
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N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
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CPT
CPT
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CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
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CPT
CPT
CPT
CPT
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CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
23334
23335
23350
23395
23397
23400
23405
23406
23410
23412
23415
23420
23430
23440
23450
23455
23460
23462
23465
23466
23470
23472
23473
23474
23480
23485
23490
23491
23500
23505
23515
23520
23525
23530
23532
23540
23545
23550
23552
23570
23575
23585
23600
23605
23615
23616
23620
23625
23630
23650
23655
23660
23665
23670
23675
23680
23700
23800
23802
23900
23920
23921
23929
23930
23931
23935
24000
24006
24065
24066
24071
24073
24075
24076
24077
24079
24100
24101
24102
24105
24110
24115
24116
24120
24125
24126
24130
24134
24136
24138
24140
PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT
PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT
INJECTION PROC, SHOULDER ARTHROGRAPHY/ENHANCED CT/
MUSCLE TRANSFER, ANY TYPE, SHOULDER/UPPER ARM; SIN
MUSCLE TRANSFER, ANY TYPE, SHOULDER/UPPER ARM; MUL
SCAPULOPEXY
TENOTOMY, SHOULDER AREA; SINGLE TENDON
TENOTOMY, SHOULDER AREA; MULTIPLE TENDONS THROUGH
REPAIR, RUPTURED MUSCULOTENDINOUS CUFF, OPEN; ACUT
REPAIR, RUPTURED MUSCULOTENDINOUS CUFF; CHRONIC
CORACOACROMIAL LIGAMENT RELEASE, W/WO ACROMIOPLAST
RECONSTRUCTION, COMPLETE SHOULDER (ROTATOR) CUFF A
TENODESIS, LONG TENDON, BICEPS
RESECTION/TRANSPLANTATION, LONG TENDON, BICEPS
CAPSULORRHAPHY, ANTERIOR; PUTTI-PLATT PROC/MAGNUSO
CAPSULORRHAPHY, ANTERIOR; W/LABRAL REPAIR
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; W/BONE BLOCK
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; W/CORACOID PRO
CAPSULORRHAPHY, GLENOHUMERAL JOINT, POSTERIOR, W/W
CAPSULORRHAPHY, GLENOHUMERAL JOINT, ANY TYPE MULTI
ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY
ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER
REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
OSTEOTOMY, CLAVICLE, W/WO INT FIXATION;
OSTEOTOMY, CLAVICLE, W/WO INT FIXATION; W/BONE GRA
PROPHYLACTIC TREATMENT W/WO METHYLMETHACRYLATE; CL
PROPHYLACTIC TREATMENT W/WO METHYLMETHACRYLATE; PR
CLOSED TREATMENT, CLAVICULAR FX; W/O MANIPULATION
CLOSED TREATMENT, CLAVICULAR FX; W/MANIPULATION
OPEN TREATMENT, CLAVICULAR FX, W/WO INT/EXT FIXATI
CLOSED TREATMENT, STERNOCLAVICULAR DISLOCATION; W/
CLOSED TREATMENT, STERNOCLAVICULAR DISLOCATION; W/
OPEN TREATMENT, STERNOCLAVICULAR DISLOCATION, ACUT
OPEN TREATMENT, STERNOCLAVICULAR DISLOCATION, ACUT
CLOSED TREATMENT, ACROMIOCLAVICULAR DISLOCATION; W
CLOSED TREATMENT, ACROMIOCLAVICULAR DISLOCATION; W
OPEN TREATMENT, ACROMIOCLAVICULAR DISLOCATION, ACU
OPEN TREATMENT, ACROMIOCLAVICULAR DISLOCATION, ACU
CLOSED TREATMENT, SCAPULAR FX; W/O MANIPULATION
CLOSED TREATMENT, SCAPULAR FX; W/MANIPULATION, W/W
OPEN TREATMENT, SCAPULAR FX, W/WO INTERNAL FIXATIO
CLOSED TREATMENT, PROXIMAL HUMERAL FX; W/O MANIPUL
CLOSED TREATMENT, PROXIMAL HUMERAL FX; W/MANIPULAT
OPEN TREATMENT, PROXIMAL HUMERAL FX, W/WO INT/EXT
OPEN TREATMENT, PROXIMAL HUMERAL FX, W/WO INT/EXT
CLOSED TREATMENT, GREATER HUMERAL TUBEROSITY FX; W
CLOSED TREATMENT, GREATER HUMERAL TUBEROSITY FX; W
OPEN TREATMENT, GREATER HUMERAL TUBEROSITY FX W/WO
CLOSED TREATMENT, SHOULDER DISLOCATION, W/MANIPULA
CLOSED TREATMENT, SHOULDER DISLOCATION, W/MANIPULA
OPEN TREATMENT, ACUTE SHOULDER DISLOCATION
CLOSED TREATMENT, SHOULDER DISLOCATION, W/FX, GREA
OPEN TREATMENT, SHOULDER DISLOCATION, W/FX, GREATE
CLOSED TREATMENT, SHOULDER DISLOCATION, W/SURGICAL
OPEN TREATMENT, SHOULDER DISLOCATION, W/SURGICAL/A
MANIPULATION W/ANESTHESIA, SHOULDER JOINT, W/APPLI
ARTHRODESIS, GLENOHUMERAL JOINT
ARTHRODESIS, GLENOHUMERAL JOINT; W/AUTOGENOUS GRAF
INTERTHORACOSCAPULAR AMPUTATION (FOREQUARTER)
DISARTICULATION, SHOULDER
DISARTICULATION, SHOULDER; SECONDARY CLOSURE/SCAR
UNLISTED PROC, SHOULDER
INCISION AND DRAINAGE, UPPER ARM/ELBOW AREA; DEEP
INCISION AND DRAINAGE, UPPER ARM/ELBOW AREA; BURSA
INCISION, DEEP, W/OPENING, BONE CORTEX, HUMERUS/EL
ARTHROTOMY, ELBOW, W/EXPLORATION, DRAINAGE/REMOVAL
ARTHROTOMY, ELBOW, W/CAPSULAR EXCISION, CAPSULAR R
BX, SOFT TISSUE, UPPER ARM/ELBOW AREA; SUPERFICIAL
BX, SOFT TISSUE, UPPER ARM/ELBOW AREA; DEEP (SUBFA
EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3+CM
EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5+CM
EXC, TUMOR, SOFT TISSUE, UPPER ARM/ELBOW AREA SUBQ
EXC, TUMOR, SOFT TISSUE, UPPER ARM/ELBOW SUBFASC
RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM
RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/>
ARTHROTOMY, ELBOW; W/SYNOVIAL BX ONLY
ARTHROTOMY, ELBOW; W/JOINT EXPLORATION, W/WO BX, W
ARTHROTOMY, ELBOW; W/SYNOVECTOMY
EXCISION, OLECRANON BURSA
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, HUMERU
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, HUMERU
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, HUMERU
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, HEAD/N
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, HEAD/N
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, HEAD/N
EXCISION, RADIAL HEAD
SEQUESTRECTOMY, SHAFT/DISTAL HUMERUS
SEQUESTRECTOMY, RADIAL HEAD/NECK
SEQUESTRECTOMY, OLECRANON PROCESS
PARTIAL EXCISION, BONE, HUMERUS
1/1/2014
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1/1/2004
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1/1/2010
1/1/2010
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1/1/2010
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1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
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12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
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N
N
N
N
N
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N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
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CPT
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CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
24145
24147
24149
24150
24152
24155
24160
24164
24200
24201
24220
24300
24301
24305
24310
24320
24330
24331
24332
24340
24341
24342
24343
24344
24345
24346
24357
24358
24359
24360
24361
24362
24363
24365
24366
24370
24371
24400
24410
24420
24430
24435
24470
24495
24498
24500
24505
24515
24516
24530
24535
24538
24545
24546
24560
24565
24566
24575
24576
24577
24579
24582
24586
24587
24600
24605
24615
24620
24635
24640
24650
24655
24665
24666
24670
24675
24685
24800
24802
24900
24920
24925
24930
24931
24935
24940
24999
25000
25001
25020
25023
PARTIAL EXCISION, BONE, RADIAL HEAD/NECK
PARTIAL EXCISION, BONE, OLECRANON PROCESS
RADICAL RESECTION, CAPSULE/SOFT TISSUE/HETEROTOPIC
RADICAL RESECTION, TUMOR, SHAFT/DISTAL HUMERUS
RADICAL RESECTION, TUMOR, RADIAL HEAD/NECK
RESECTION, ELBOW JOINT (ARTHRECTOMY)
PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS
PROSTHESIS REMOVAL RADIAL HEAD
REMOVAL, FB, UPPER ARM/ELBOW AREA; SUBQ
REMOVAL, FB, UPPER ARM/ELBOW AREA; DEEP (SUBFASCIA
INJECTION PROC, ELBOW ARTHROGRAPHY
MANIPULATION, ELBOW, UNDER ANESTHESIA
MUSCLE/TENDON TRANSFER, ANY TYPE, UPPER ARM/ELBOW,
TENDON LENGTHENING, UPPER ARM/ELBOW, EACH TENDON
TENOTOMY, OPEN, ELBOW TO SHOULDER, EACH TENDON
TENOPLASTY, W/MUSCLE TRANSFER, W/WO FREE GRAFT, EL
FLEXOR-PLASTY, ELBOW
FLEXOR-PLASTY, ELBOW; W/EXTENSOR ADVANCEMENT
TENOLYSIS, TRICEPS
TENODESIS, BICEPS TENDON AT ELBOW (SEP PROC)
REPAIR, TENDON/MUSCLE, UPPER ARM/ELBOW, EACH TENDO
REINSERTION, RUPTURED BICEPS/TRICEPS TENDON, DISTA
REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, W/LOCAL
RECONSTRUCTION LATERAL COLLATERAL LIGAMENT, ELBOW,
REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW, W/LOCAL
RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW,
TENOTOMY, ELBOW, LATERAL OR MEDIAL EG, EPICONDYLIT
DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN
DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN WITH TE
ARTHROPLASTY, ELBOW; W/MEMBRANE
ARTHROPLASTY, ELBOW; W/DISTAL HUMERAL PROSTHETIC R
ARTHROPLASTY, ELBOW; W/IMPLANT AND FASCIA LATA LIG
ARTHROPLASTY, ELBOW; W/DISTAL HUMERUS/PROXIMAL ULN
ARTHROPLASTY, RADIAL HEAD
ARTHROPLASTY, RADIAL HEAD; W/IMPLANT
REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT
REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT
OSTEOTOMY, HUMERUS, W/WO INT FIXATION
MULTIPLE OSTEOTOMIES W/REALIGNMENT ON INTRAMEDULLA
OSTEOPLASTY, HUMERUS (EXCLUDING 64876)
REPAIR, NONUNION/MALUNION, HUMERUS; W/O GRAFT
REPAIR, NONUNION/MALUNION, HUMERUS; W/ILIAC/OTHER
HEMIEPIPHYSEAL ARREST
DECOMPRESSION FASCIOTOMY, FOREARM, W/BRACHIAL ARTE
PROPHYLACTIC TREATMENT, W/WO METHYLMETHACRYLATE, H
CLOSED TREATMENT, HUMERAL SHAFT FX; W/O MANIPULATI
CLOSED TREATMENT, HUMERAL SHAFT FX; W/MANIPULATION
OPEN TREATMENT, HUMERAL SHAFT FX W/PLATE/SCREWS, W
TREATMENT, HUMERAL SHAFT FX, W/INSERTION, INTRAMED
CLOSED TREATMENT, SUPRACONDYLAR/TRANSCONDYLAR HUME
CLOSED TREATMENT, SUPRACONDYLAR/TRANSCONDYLAR HUME
PERCUTANEOUS SKELETAL FIXATION, SUPRACONDYLAR/TRAN
OPEN TREATMENT, HUMERAL SUPRACONDYLAR/TRANSCONDYLA
OPEN TREATMENT, HUMERAL SUPRACONDYLAR/TRANSCONDYLA
CLOSED TREATMENT, HUMERAL EPICONDYLAR FX, MEDIAL/L
CLOSED TREATMENT, HUMERAL EPICONDYLAR FX, MEDIAL/L
PERCUTANEOUS SKELETAL FIXATION, HUMERAL EPICONDYLA
OPEN TREATMENT, HUMERAL EPICONDYLAR FX, MEDIAL/LAT
CLOSED TREATMENT, HUMERAL CONDYLAR FX, MEDIAL/LATE
CLOSED TREATMENT, HUMERAL CONDYLAR FX, MEDIAL/LATE
OPEN TREATMENT, HUMERAL CONDYLAR FX, MEDIAL/LATERA
PERCUTANEOUS SKELETAL FIXATION, HUMERAL CONDYLAR F
OPEN TREATMENT, PERIARTICULAR FX/DISLOCATION, ELBO
OPEN TREATMENT, PERIARTICULAR FX/DISLOCATION, ELBO
TREATMENT, CLOSED ELBOW DISLOCATION; W/O ANESTHESI
TREATMENT, CLOSED ELBOW DISLOCATION; REQUIRING ANE
OPEN TREATMENT, ACUTE/CHRONIC ELBOW DISLOCATION
CLOSED TREATMENT, MONTEGGIA TYPE, FX DISLOCATION,
OPEN TREATMENT, MONTEGGIA TYPE, FX DISLOCATION, EL
CLOSED TREATMENT, RADIAL HEAD SUBLUXATION IN CHILD
CLOSED TREATMENT, RADIAL HEAD/NECK FX; W/O MANIPUL
CLOSED TREATMENT, RADIAL HEAD/NECK FX; W/MANIPULAT
OPEN TREATMENT, RADIAL HEAD/NECK FX W/WO INT FIXAT
OPEN TREATMENT, RADIAL HEAD/NECK FX W/WO INT FIXAT
CLOSED TREATMENT, ULNAR FX, PROXIMAL END (OLECRANO
CLOSED TREATMENT, ULNAR FX, PROXIMAL END (OLECRANO
OPEN TREATMENT, ULNAR FX, PROXIMAL END (OLECRANON
ARTHRODESIS, ELBOW JOINT; LOCAL
ARTHRODESIS, ELBOW JOINT; W/AUTOGENOUS GRAFT (INCL
AMPUTATION, ARM THROUGH HUMERUS; W/PRIMARY CLOSURE
AMPUTATION, ARM THROUGH HUMERUS; OPEN, CIRCULAR (G
AMPUTATION, ARM THROUGH HUMERUS; SECONDARY CLOSURE
AMPUTATION, ARM THROUGH HUMERUS; RE-AMPUTATION
AMPUTATION, ARM THROUGH HUMERUS; W/IMPLANT
STUMP ELONGATION, UPPER EXTREMITY
CINEPLASTY, UPPER EXTREMITY, COMPLETE PROC
UNLISTED PROC, HUMERUS/ELBOW
INCISION, EXTENSOR TENDON SHEATH, WRIST
INCISION, FLEXOR TENDON SHEATH, WRIST
DECOMPRES FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR
DECOMPRES FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
25024
25025
25028
25031
25035
25040
25065
25066
25071
25073
25075
25076
25077
25078
25085
25100
25101
25105
25107
25109
25110
25111
25112
25115
25116
25118
25119
25120
25125
25126
25130
25135
25136
25145
25150
25151
25170
25210
25215
25230
25240
25246
25248
25250
25251
25259
25260
25263
25265
25270
25272
25274
25275
25280
25290
25295
25300
25301
25310
25312
25315
25316
25320
25332
25335
25337
25350
25355
25360
25365
25370
25375
25390
25391
25392
25393
25394
25400
25405
25415
25420
25425
25426
25430
25431
25440
25441
25442
25443
25444
25445
DECOMPRES FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR
DECOMPRES FASCIOTOMY, FOREARM AND/OR WRIST, FLEXOR
INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP
INCISION AND DRAINAGE, FOREARM AND/OR WRIST; BURSA
INCISION, DEEP, BONE CORTEX, FOREARM AND/OR WRIST
ARTHROTOMY, RADIOCARPAL/MIDCARPAL JOINT, W/EXPLORE
BX, SOFT TISSUE, FOREARM AND/OR WRIST; SUPERFICIAL
BX, SOFT TISSUE, FOREARM AND/OR WRIST; DEEP (SUBFA
EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3+CM
EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM
EXC, TUMOR, SOFT TISSUE FOREARM AND/OR WRIST SUBQ
EXC, TUMOR, SFT TISSUE FOREARM AND/OR WRIST SUBFAS
RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM
RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>
CAPSULOTOMY, WRIST
ARTHROTOMY, WRIST JOINT; W/BX
ARTHROTOMY, WRIST JOINT; W/JOINT EXPLORATION, W/WO
ARTHROTOMY, WRIST JOINT; W/SYNOVECTOMY
ARTHROTOMY, DISTAL RADIOULNAR JOINT W/REPAIR, TRIA
Excise tendon forearm/wrist
EXCISION, LESION, TENDON SHEATH, FOREARM AND/OR WR
EXCISION, GANGLION, WRIST (DORSAL/VOLAR); PRIMARY
EXCISION, GANGLION, WRIST (DORSAL/VOLAR); RECURREN
RADICAL EXCISION, BURSA, SYNOVIA, WRIST/FOREARM TE
RADICAL EXCISION, BURSA, SYNOVIA, WRIST/FOREARM TE
SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE
SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, RADIUS
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, RADIUS
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, RADIUS
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, CARPAL
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, CARPAL
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, CARPAL
SEQUESTRECTOMY, FOREARM AND/OR WRIST
PARTIAL EXCISION, BONE; ULNA
PARTIAL EXCISION, BONE; RADIUS
RADICAL RESECTION, TUMOR, RADIUS/ULNA
CARPECTOMY; ONE BONE
CARPECTOMY; ALL BONES, PROXIMAL ROW
RADIAL STYLOIDECTOMY (SEP PROC)
EXCISION DISTAL ULNA PARTIAL/COMPLETE
INJECTION PROC, WRIST ARTHROGRAPHY
EXPLORATION W/REMOVAL, DEEP FB, FOREARM/WRIST
REMOVAL, WRIST PROSTHESIS; (SEP PROC)
REMOVAL, WRIST PROSTHESIS; COMPLICATED, W/TOTAL WR
MANIPULATION, WRIST, UNDER ANESTHESIA
REPAIR, TENDON/MUSCLE, FLEXOR, FOREARM AND/OR WRIS
REPAIR, TENDON/MUSCLE, FLEXOR, FOREARM AND/OR WRIS
REPAIR, TENDON/MUSCLE, FLEXOR, FOREARM AND/OR WRIS
REPAIR, TENDON/MUSCLE, EXTENSOR, FOREARM AND/OR WR
REPAIR, TENDON/MUSCLE, EXTENSOR, FOREARM AND/OR WR
REPAIR, TENDON/MUSCLE, EXTENSOR, FOREARM AND/OR WR
REPAIR, TENDON SHEATH, EXTENSOR, FOREARM AND/OR WR
LENGTHENING/SHORTENING, FLEXOR/EXTENSOR TENDON, FO
TENOTOMY, OPEN, FLEXOR/EXTENSOR TENDON, FOREARM AN
TENOLYSIS, FLEXOR/EXTENSOR TENDON, FOREARM AND/OR
TENODESIS AT WRIST; FLEXORS, FINGERS
TENODESIS AT WRIST; EXTENSORS, FINGERS
TENDON TRANSPLANTATION/TRANSFER, FLEXOR/EXTENSOR,
TENDON TRANSPLANTATION/TRANSF, FLEXOR/EXTENS, FORE
FLEXOR ORIGIN SLIDE, FOREARM AND/OR WRIST
FLEXOR ORIGIN SLIDE, FOREARM AND/OR WRIST; W/TENDO
CAPSULORRHAPHY/RECONSTRUCTION, WRIST, OPEN, W/SYNO
ARTHROPLASTY, WRIST, W/WO INTERPOSITION/INT/EXT FI
CENTRALIZATION, WRIST ON ULNA
RECONSTRUCTION, STABILIZATION, DISTAL ULNA/RADIOUL
OSTEOTOMY, RADIUS; DISTAL THIRD
OSTEOTOMY, RADIUS; MIDDLE/PROXIMAL THIRD
OSTEOTOMY; ULNA
OSTEOTOMY; RADIUS AND ULNA
MULTIPLE OSTEOTOMIES, W/REALIGNMENT ON INTRAMEDULL
MULTIPLE OSTEOTOMIES, W/REALIGNMENT ON INTRAMEDULL
OSTEOPLASTY, RADIUS/ULNA; SHORTENING
OSTEOPLASTY, RADIUS/ULNA; LENGTHENING W/AUTOGRAFT
OSTEOPLASTY, RADIUS AND ULNA; SHORTENING (EXCLUDIN
OSTEOPLASTY, RADIUS AND ULNA; LENGTHENING W/AUTOGR
OSTEOPLASTY, CARPAL BONE, SHORTENING
REPAIR, NONUNION/MALUNION, RADIUS/ULNA; W/O GRAFT
REPAIR, NONUNION/MALUNION, RADIUS/ULNA; W/AUTOGRAF
REPAIR, NONUNION/MALUNION, RADIUS AND ULNA; W/O GR
REPAIR, NONUNION/MALUNION, RADIUS AND ULNA; W/AUTO
REPAIR, DEFECT W/AUTOGRAFT; RADIUS/ULNA
REPAIR, DEFECT W/AUTOGRAFT; RADIUS AND ULNA
INSERTION, VASCULAR PEDICLE, CARPAL BONE (HARII PR
REPAIR, NONUNION, CARPAL BONE (EXCL CARPAL SCAPHOI
REPAIR, NONUNION, SCAPHOID CARPAL BONE, W/WO RADIA
ARTHROPLASTY W/PROSTHETIC REPLACEMENT; DISTAL RADI
ARTHROPLASTY W/PROSTHETIC REPLACEMENT; DISTAL ULNA
ARTHROPLASTY W/PROSTHETIC REPLACEMENT; SCAPHOID CA
ARTHROPLASTY W/PROSTHETIC REPLACEMENT; LUNATE
ARTHROPLASTY W/PROSTHETIC REPLACEMENT; TRAPEZIUM
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
25446
25447
25449
25450
25455
25490
25491
25492
25500
25505
25515
25520
25525
25526
25530
25535
25545
25560
25565
25574
25575
25600
25605
25606
25607
25608
25609
25622
25624
25628
25630
25635
25645
25650
25651
25652
25660
25670
25671
25675
25676
25680
25685
25690
25695
25800
25805
25810
25820
25825
25830
25900
25905
25907
25909
25915
25920
25922
25924
25927
25929
25931
25999
26010
26011
26020
26025
26030
26034
26035
26037
26040
26045
26055
26060
26070
26075
26080
26100
26105
26110
26111
26113
26115
26116
26117
26118
26121
26123
26125
26130
ARTHROPLASTY W/PROSTHETIC REPLACEMENT; DISTAL RADI
ARTHROPLASTY, INTERPOSITION, INTERCARPAL/CARPOMETA
REVISION, ARTHROPLASTY, W/REMOVAL, IMPLANT, WRIST
EPIPHYSEAL ARREST, EPIPHYSIODESIS/STAPLING; DISTAL
EPIPHYSEAL ARREST, EPIPHYSIODESIS/STAPLING; DISTAL
PROPHYLACTIC TREATMENT (NAIL/PIN/PLATE/WIRE) W/WO
PROPHYLACTIC TREATMENT (NAIL/PIN/PLATE/WIRE) W/WO
PROPHYLACTIC TREATMENT (NAIL/PIN/PLATE/WIRE) W/WO
CLOSED TREATMENT, RADIAL SHAFT FX; W/O MANIPULATIO
CLOSED TREATMENT, RADIAL SHAFT FX; W/MANIPULATION
OPEN TREATMENT, RADIAL SHAFT FX, W/WO INT/EXT FIXA
CLOSED TREATMENT, RADIAL SHAFT FX, AND DISLOCATION
OPEN TREATMENT, RADIAL SHAFT FX, W/FIXATION AND CL
OPEN TX, RADIAL SHAFT FX AND DISTAL RADIOULNAR JT,
CLOSED TREATMENT, ULNAR SHAFT FX; W/O MANIPULATION
CLOSED TREATMENT, ULNAR SHAFT FX; W/MANIPULATION
OPEN TREATMENT, ULNAR SHAFT FX, W/WO INT/EXT FIXAT
CLOSED TREATMENT, RADIAL AND ULNAR SHAFT FXS; W/O
CLOSED TREATMENT, RADIAL AND ULNAR SHAFT FXS; W/MA
OPEN TREATMENT, RADIAL AND ULNAR SHAFT FXS, W/INT/
OPEN TREATMENT, RADIAL AND ULNAR SHAFT FXS, W/INT/
CLOSED TREATMENT, DISTAL RADIAL FX/EPIPHYSEAL SEPA
CLOSED TREATMENT, DISTAL RADIAL FX/EPIPHYSEAL SEPA
Treat fx distal radial
Treat fx rad extra-articul
Treat fx rad intra-articul
Treat fx radial 3+ frag
CLOSED TREATMENT, CARPAL SCAPHOID (NAVICULAR) FX;
CLOSED TREATMENT, CARPAL SCAPHOID (NAVICULAR) FX;
OPEN TREATMENT, CARPAL SCAPHOID (NAVICULAR) FX, W/
CLOSED TREATMENT, CARPAL BONE FX (EXCLUDING CARPAL
CLOSED TREATMENT, CARPAL BONE FX (EXCLUDING CARPAL
OPEN TREATMENT, CARPAL BONE FX (EXCLUDING CARPAL S
CLOSED TREATMENT, ULNAR STYLOID FX
PERCUTANEOUS SKELETAL FIXATION, ULNAR STYLOID FRAC
OPEN TREATMENT, ULNAR STYLOID FRACTURE
CLOSED TREATMENT, RADIOCARPAL/INTERCARPAL DISLOCAT
OPEN TREATMENT, RADIOCARPAL/INTERCARPAL DISLOCATIO
PERCUTANEOUS SKELETAL FIXATION, DISTAL RADIOULNAR
CLOSED TREATMENT, DISTAL RADIOULNAR DISLOCATION W/
OPEN TREATMENT, DISTAL RADIOULNAR DISLOCATION, ACU
CLOSED TREATMENT, TRANS-SCAPHOPERILUNAR TYPE FX DI
OPEN TREATMENT, TRANS-SCAPHOPERILUNAR TYPE FX DISL
CLOSED TREATMENT, LUNATE DISLOCATION, W/MANIPULATI
OPEN TREATMENT, LUNATE DISLOCATION
ARTHRODESIS, WRIST; COMPLETE W/O BONE GRAFT
ARTHRODESIS, WRIST; W/SLIDING GRAFT
ARTHRODESIS, WRIST; W/ILIAC/OTHER AUTOGRAFT (INCLU
ARTHRODESIS, WRIST; LIMITED, W/O BONE GRAFT
ARTHRODESIS, WRIST; W/AUTOGRAFT (INCLUDES OBTAININ
ARTHRODESIS, DISTAL RADIOULNAR JOINT AND SEGMENTAL
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; OPEN
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; SECO
AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; RE-A
KRUKENBERG PROC
DISARTICULATION THROUGH WRIST
DISARTICULATION THROUGH WRIST; SECONDARY CLOSURE/S
DISARTICULATION THROUGH WRIST; RE-AMPUTATION
TRANSMETACARPAL AMPUTATION
TRANSMETACARPAL AMPUTATION; SECONDARY CLOSURE/SCAR
TRANSMETACARPAL AMPUTATION; RE-AMPUTATION
UNLISTED PROC, FOREARM/WRIST
DRAINAGE, FINGER ABSCESS; SIMPLE
DRAINAGE, FINGER ABSCESS; COMPLICATED
DRAINAGE, TENDON SHEATH, DIGIT AND/OR PALM, EACH
DRAINAGE, PALMAR BURSA; SINGLE, BURSA
DRAINAGE, PALMAR BURSA; MULTIPLE BURSA
INCISION, BONE CORTEX, HAND/FINGER
DECOMPRESSION FINGERS AND/OR HAND, INJECTION INJUR
DECOMPRESSIVE FASCIOTOMY, HAND (EXCLUDES 26035)
FASCIOTOMY, PALMAR; PERCUTANEOUS
FASCIOTOMY, PALMAR; OPEN, PARTIAL
TENDON SHEATH INCISION
TENOTOMY, PERCUTANEOUS, SINGLE, EACH DIGIT
ARTHROTOMY, EXPLORATION/DRAINAGE/REMOVAL, LOOSE/FB
ARTHROTOMY, EXPLORATION/DRAINAGE/REMOVAL, LOOSE/FB
ARTHROTOMY, EXPLORATION/DRAINAGE/REMOVAL, LOOSE/FB
ARTHROTOMY W/BX; CARPOMETACARPAL JOINT, EACH
ARTHROTOMY W/BX; METACARPOPHALANGEAL JOINT, EACH
ARTHROTOMY W/BX; INTERPHALANGEAL JOINT, EACH
EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM
EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5+CM
EXC, TUMOR/VASCLAR MALFORMATION, SOFT TISS SUBQ
EXC, TUMOR/VASCLAR MALFORMATION, SOFT TISS SUBFASC
RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM
RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/>
FASCIECTOMY, PALM ONLY W/WO Z-PLASTY/LOCAL TISSUE
FASCIECTOMY, PARTIAL PALMAR W/RELEASE, SINGLE DIGI
FASCIECTOM, PARTL PALMAR W/RELEASE, SNGL DIGIT, W/
SYNOVECTOMY, CARPOMETACARPAL JOINT
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
26135
26140
26145
26160
26170
26180
26185
26200
26205
26210
26215
26230
26235
26236
26250
26260
26262
26320
26340
26341
26350
26352
26356
26357
26358
26370
26372
26373
26390
26392
26410
26412
26415
26416
26418
26420
26426
26428
26432
26433
26434
26437
26440
26442
26445
26449
26450
26455
26460
26471
26474
26476
26477
26478
26479
26480
26483
26485
26489
26490
26492
26494
26496
26497
26498
26499
26500
26502
26508
26510
26516
26517
26518
26520
26525
26530
26531
26535
26536
26540
26541
26542
26545
26546
26548
26550
26551
26553
26554
26555
26556
SYNOVECTOMY, METACARPOPHALANGEAL JOINT, W/INTRINSI
SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, W/EXT
SYNOVECTOMY, TENDON SHEATH, RADICAL, FLEXOR TENDON
EXCISION, LESION, TENDON SHEATH/JOINT CAPSULE, HAN
EXCISION, TENDON, PALM, FLEXOR, SINGLE (SEP PROC),
EXCISION, TENDON, FINGER, FLEXOR (SEP PROC), EACH
SESAMOIDECTOMY, THUMB/FINGER (SEP PROC)
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, METACA
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, METACA
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, PHALAN
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, PHALAN
PARTIAL EXCISION, BONE; METACARPAL
PARTIAL EXCISION, BONE; PROXIMAL/MIDDLE PHALANX, F
PARTIAL EXCISION, BONE; DISTAL PHALANX, FINGER
RADICAL RESECTION TUMOR METACARPAL
RAD RESECTION TUMOR PROX/MIDDLE PHALANX FINGER
RADICAL RESECTION TUMOR DISTAL PHALANX FINGER
REMOVAL, IMPLANT, FINGER/HAND
MANIPULATION, FINGER JOINT, UNDER ANESTHESIA, EACH
MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
FLEXOR TENDON REPAIR/ADVANCE, NOT IN ZONE 2 (NO MA
FLEXOR TENDON, REPAIR/ADVANCE, NOT IN (NO MANS LAN
FLEXOR TENDON, REPAIR/ADVANCE, IN ZONE 2 (NO MANS
FLEXOR TENDON, REPAIR/ADVANCE, IN ZONE 2 (NO MANS
FLEXOR TENDON, REPAIR/ADVANCE, IN ZONE 2 (NO MANS
PROFUNDUS TENDON REPAIR/ADVANCE, W/INTACT SUPERFIC
PROFUNDUS TENDON REPAIR/ADVANCE, W/INTACT SUPERFIC
PROFUNDUS TENDON REPAIR/ADVANCE, W/INTACT SUPERFIC
FLEXOR TENDON EXCISION, IMPLANTATION SYNTHETIC ROD
REMOVAL, SYNTHETIC ROD AND INSERTION, FLEXOR TENDO
REPAIR, EXTENSOR TENDON, HAND, PRIMARY/SECONDARY;
REPAIR, EXTENSOR TENDON, HAND, PRIMARY/SECONDARY;
EXTENSOR TENDON EXCISION, IMPLANTATION SYNTHETIC R
REMOVAL, SYNTHETIC ROD AND INSERTION, EXTENSOR TEN
REPAIR, EXTENSOR TENDON, FINGER, PRIMARY/SECONDARY
REPAIR, EXTENSOR TENDON, FINGER, PRIMARY/SECONDARY
REPAIR, EXTENSOR TENDON, CENTRAL SLIP, SECONDARY;
REPAIR, EXTENSOR TENDON, CENTRAL SLIP, SECONDARY;
CLOSED TREATMENT, EXTENSOR TENDON, DISTAL INSERTIO
REPAIR, EXTENSOR TENDON, DISTAL INSERTION, PRIMARY
REPAIR, EXTENSOR TENDON, DISTAL INSERTION, PRIMARY
REALIGNMENT, EXTENSOR TENDON, HAND, EACH TENDON
TENOLYSIS, FLEXOR TENDON; PALM/FINGER, EACH TENDON
TENOLYSIS, FLEXOR TENDON; PALM AND FINGER, EACH TE
TENOLYSIS, EXTENSOR TENDON, HAND/FINGER; EACH TEND
TENOLYSIS, COMPLEX, EXTENSOR TENDON, FINGER, W/FOR
TENOTOMY, FLEXOR, PALM, OPEN, EACH TENDON
TENOTOMY, FLEXOR, FINGER, OPEN, EACH TENDON
TENOTOMY, EXTENSOR, HAND/FINGER, OPEN, EACH TENDON
TENODESIS; PROXIMAL INTERPHALANGEAL JOINT, EACH JO
TENODESIS; DISTAL JOINT, EACH JOINT
LENGTHENING, TENDON, EXTENSOR, HAND/FINGER, EACH T
SHORTENING, TENDON, EXTENSOR, HAND/FINGER, EACH TE
LENGTHENING, TENDON, FLEXOR, HAND/FINGER, EACH TEN
SHORTENING, TENDON, FLEXOR, HAND/FINGER, EACH TEND
TENDON TRANSFER/TRANSPLANT, CARPOMETACARPAL/DORSUM
TENDON TRANSFER/TRANSPLANT, CARPOMETACARPAL/DORSUM
TENDON TRANSFER/TRANSPLANT, PALMAR; W/O FREE TENDO
TENDON TRANSFER/TRANSPLANT, PALMAR; W/FREE TENDON
OPPONENSPLASTY; SUPERFICIALIS TENDON TRANSFER TYPE
OPPONENSPLASTY; TENDON TRANSFER W/GRAFT (INCLUDES
OPPONENSPLASTY; HYPOTHENAR MUSCLE TRANSFER
OPPONENSPLASTY; OTHER METHODS
TRANSFER, TENDON TO RESTORE INTRINSIC FUNCTION; RI
TRANSFER, TENDON TO RESTORE INTRINSIC FUNCTION; AL
CORRECTION CLAW FINGER, OTHER METHODS
RECONSTRUCTION, TENDON PULLEY, EACH TENDON; W/LOCA
RECONSTRUCTION, TENDON PULLEY, EACH TENDON; W/TEND
RELEASE, THENAR MUSCLE(S)
CROSS INTRINSIC TRANSFER, EACH TENDON
CAPSULODESIS, METACARPOPHALANGEAL JOINT; SINGLE DI
CAPSULODESIS, METACARPOPHALANGEAL JOINT; TWO DIGIT
CAPSULODESIS, METACARPOPHALANGEAL JOINT; THREE/FOU
CAPSULECTOMY/CAPSULOTOMY; METACARPOPHALANGEAL JOIN
CAPSULECTOMY/CAPSULOTOMY; INTERPHALANGEAL JOINT, E
ARTHROPLASTY, METACARPOPHALANGEAL JOINT; EACH JOIN
ARTHROPLASTY, METACARPOPHALANGEAL JOINT; W/PROSTHE
ARTHROPLASTY, INTERPHALANGEAL JOINT; EACH JOINT
ARTHROPLASTY, INTERPHALANGEAL JOINT; W/PROSTHETIC
REPAIR, COLLATERAL LIGAMENT, METACARPOPHALANGEAL/I
RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHAL
PRIMARY REPAIR, COLLATERAL LIGAMENT, METACARPOPHAL
RECONSTRUCTION, COLLATERAL LIGAMENT, INTERPHALANGE
REPAIR, NONUNION, METACARPAL/PHALANX, (INCLUDES OB
REPAIR AND RECONSTRUCTION, FINGER, VOLAR PLATE, IN
POLLICIZATION, DIGIT
TRANSFER, TOE-TO-HAND W/MICROVASCULAR ANASTOMOSIS;
TRANSFER, TOE-TO-HAND W/MICROVASCULAR ANASTOMOSIS;
TRANSFER, TOE-TO-HAND W/MICROVASCULAR ANASTOMOSIS;
TRANSFER, FINGER TO ANOTHER POSITION W/O MICROVASC
TRANSFER, FREE TOE JOINT, W/MICROVASCULAR ANASTOMO
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
26560
26561
26562
26565
26567
26568
26580
26587
26590
26591
26593
26596
26600
26605
26607
26608
26615
26641
26645
26650
26665
26670
26675
26676
26685
26686
26700
26705
26706
26715
26720
26725
26727
26735
26740
26742
26746
26750
26755
26756
26765
26770
26775
26776
26785
26820
26841
26842
26843
26844
26850
26852
26860
26861
26862
26863
26910
26951
26952
26989
26990
26991
26992
27000
27001
27003
27005
27006
27025
27027
27030
27033
27035
27036
27040
27041
27043
27045
27047
27048
27049
27050
27052
27054
27057
27059
27060
27062
27065
27066
27067
REPAIR, SYNDACTYLY (WEB FINGER) EACH WEB SPACE; W/
REPAIR, SYNDACTYLY (WEB FINGER) EACH WEB SPACE; W/
REPAIR, SYNDACTYLY (WEB FINGER) EACH WEB SPACE; CO
OSTEOTOMY; METACARPAL, EACH
OSTEOTOMY; PHALANX, FINGER, EACH
OSTEOPLASTY, LENGTHENING, METACARPAL/PHALANX
REPAIR CLEFT HAND
RECONSTRUCTION, POLYDACTYLOUS DIGIT, SOFT TISSUE A
REPAIR MACRODACTYLIA, EACH DIGIT
REPAIR, INTRINSIC MUSCLES, HAND, EACH MUSCLE
RELEASE, INTRINSIC MUSCLES, HAND, EACH MUSCLE
EXCISION, CONSTRICTING RING, FINGER, W/MULTIPLE ZCLOSED TREATMENT, METACARPAL FX, SINGLE; W/O MANIP
CLOSED TREATMENT, METACARPAL FX, SINGLE; W/MANIPUL
CLOSED TREATMENT, METACARPAL FX, W/MANIPULATION, W
PERCUTANEOUS SKELETAL FIXATION, METACARPAL FX, EAC
OPEN TREATMENT, METACARPAL FX, SINGLE, W/WO INT/EX
CLOSED TREATMENT, CARPOMETACARPAL DISLOCATION, THU
CLOSED TREATMENT, CARPOMETACARPAL FX/DISLOCATION,
PERCUTANEOUS SKELETAL FIXATION, CARPOMETACARPAL FX
OPEN TREATMENT, CARPOMETACARPAL FX DISLOCATION, TH
CLOSED TX, CARPOMETACARPAL DISLOCATION, NON-THUMB
CLOSED TREATMENT, CARPOMETACARPAL DISLOCATION, NON
PERCUTANEOUS SKELETAL FIXATION, CARPOMETACARPAL DI
OPEN TREATMENT, CARPOMETACARPAL DISLOCATION, NON-T
OPEN TREATMENT, CARPOMETACARPAL DISLOCATION, NON-T
CLOSED TREATMENT, METACARPOPHALANGEAL DISLOCATION,
CLOSED TREATMENT, METACARPOPHALANGEAL DISLOCATION,
PERCUTANEOUS SKELETAL FIXATION, METACARPOPHALANGEA
OPEN TREATMENT, METACARPOPHALANGEAL DISLOCATION, S
CLOSED TREATMENT, PHALANGEAL SHAFT FX, PROXIMAL/MI
CLOSED TREATMENT, PHALANGEAL SHAFT FX, PROXIMAL/MI
PERCUTAN SKELETAL FIXATN, UNSTABLE PHALANGL SHAFT
OPEN TREATMENT, PHALANGEAL SHAFT FX, PROXIMAL/MIDD
CLOSED TREATMENT, ARTICULAR FX, MCP/IP JOINT; W/O
CLOSED TREATMENT, ARTICULAR FX, MCP/IP JOINT; W/MA
OPEN TREATMENT, ARTICULAR FX, INVOLVING MCP/IP JOI
CLOSED TREATMENT, DISTAL PHALANGEAL FX, FINGER/THU
CLOSED TREATMENT, DISTAL PHALANGEAL FX, FINGER/THU
PERCUTANEOUS SKELETAL FIXATION, DISTAL PHALANGEAL
OPEN TREATMENT, DISTAL PHALANGEAL FX, FINGER/THUMB
CLOSED TREATMENT, IP JOINT DISLOCATION, SINGLE, W/
CLSD TRTMT INTERPHALANGEL JT DISLOCATION, REQ ANES
PERCUTANEOUS SKELETAL FIXATION, IP JOINT DISLOCATI
OPEN TREATMENT, IP JOINT DISLOCATION, W/WO INT/EXT
FUSION IN OPPOSITION, THUMB, W/AUTOGENOUS GRAFT (I
ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, W/WO IN
ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, W/WO IN
ARTHRODESIS, CARPOMETACARPAL JOINT, DIGIT, OTHER T
ARTHRODESIS, CARPOMETACARPAL JOINT, DIGIT, OTHER T
ARTHRODESIS, METACARPOPHALANGEAL JOINT, W/WO INT F
ARTHRODESIS, METACARPOPHALANGEAL JOINT W/WO INT FI
ARTHRODESIS, INTERPHALANGEAL JOINT, W/WO INT FIXAT
ARTHRODESIS, INTERPHALANGEAL JOINT, W/WO INT FIXAT
ARTHRODESIS, INTERPHALANGEAL JOINT, W/WO INT FIXAT
ARTHRODESIS, INTERPHALANGEAL JOINT, W/WO INT FIXAT
AMPUTATION, METACARPAL, W/FINGER/THUMB, SINGLE, W/
AMPUTATION, FINGER/THUMB, PRIMARY/SECOND, ANY JNT/
AMPUTATION, FINGER/THUMB, PRIMARY/SECOND, ANY JNT/
UNLISTED PROC, HANDS/FINGERS
INCISION AND DRAINAGE, PELVIS/HIP JOINT AREA; DEEP
INCISION AND DRAINAGE, PELVIS/HIP JOINT AREA; INFE
INCISION, BONE CORTEX, PELVIS AND/OR HIP JOINT
TENOTOMY, ADDUCTOR, HIP, PERCUTANEOUS (SEP PROC)
TENOTOMY, ADDUCTOR, HIP, OPEN
TENOTOMY, ADDUCTOR, SUBQ, OPEN, W/OBTURATOR NEUREC
TENOTOMY, HIP FLEXOR(S), OPEN (SEP PROC)
TENOTOMY, ABDUCTORS AND/OR EXTENSOR(S), HIP, OPEN
FASCIOTOMY, HIP/THIGH, ANY TYPE
DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI
ARTHROTOMY, HIP, W/DRAINAGE
ARTHROTOMY, HIP, W/EXPLORATION/REMOVAL, LOOSE/FB
HIP JOINT DENERVATION, INTRAARTICULAR BRANCHES, SC
CAPSULECTOMY/CAPSULOTOMY, HIP, W/HIP FLEXOR MUSCLE
BX, SOFT TISSUE, PELVIS AND HIP AREA; SUPERFICIAL
BX, SOFT TISSUE, PELVIS AND HIP AREA; DEEP, SUBFAS
EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM
EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5+CM
EXCISION, TUMOR, PELVIS AND HIP AREA; SUBQ TISSUE
EXCISION, TUMOR, PELVIS AND HIP AREA; DEEP, SUBFAS
RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM
ARTHROTOMY, W/BX; SACROILIAC JOINT
ARTHROTOMY, W/BX; HIP JOINT
ARTHROTOMY, W/SYNOVECTOMY, HIP JOINT
DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/>
EXCISION; ISCHIAL BURSA
EXCISION; TROCHANTERIC BURSA/CALCIFICATION
EXCISION BONE CYST/B9 TUMOR SUPERFICIAL
EXCISION BONE CYST/B9 TUMOR DEEP
EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
27070
27071
27075
27076
27077
27078
27080
27086
27087
27090
27091
27093
27095
27096
27097
27098
27100
27105
27110
27111
27120
27122
27125
27130
27132
27134
27137
27138
27140
27146
27147
27151
27156
27158
27161
27165
27170
27175
27176
27177
27178
27179
27181
27185
27187
27193
27194
27200
27202
27215
27216
27217
27218
27220
27222
27226
27227
27228
27230
27232
27235
27236
27238
27240
27244
27245
27246
27248
27250
27252
27253
27254
27256
27257
27258
27259
27265
27266
27267
27268
27269
27275
27279
27280
27282
27284
27286
27290
27295
27299
27301
PARTIAL EXCISION SUPERFICIAL PELVIS
PARTIAL EXCISION DEEP PELVIS
RAD RESCT TUMOR WING OF ILIUM 1 PUBIC/ISCHIAL
RAD RESCT TUMOR ILIUM ACETABULUM BOTH PUBIC
RADICAL RESCTION TUMOR INNOMINATE BONE TOTAL
RAD RESCT TUMOR ISCHIAL TUBEROSITY&GRT TRCHNTR
COCCYGECTOMY, PRIMARY
REMOVAL, FB, PELVIS/HIP; SUBQ TISSUE
REMOVAL, FB, PELVIS/HIP; DEEP (SUBFASCIAL/IM)
REMOVAL, HIP PROSTHESIS; (SEP PROC)
REMOVAL, HIP PROSTHESIS; COMPLICATED, W/TOTAL HIP
INJECTION PROC, HIP ARTHROGRAPHY; W/O ANESTHESIA
INJECTION PROC, HIP ARTHROGRAPHY; W/ANESTHESIA
INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMAGE
RELEASE/RECESSION, HAMSTRING, PROXIMAL
TRANSFER, ADDUCTOR TO ISCHIUM
TRANSFER EXT OBLIQUE MUSCLE TO GREATER TROCHANTER
TRANSFER PARASPINAL MUSCLE TO HIP (INCLUDES FASCIA
TRANSFER ILIOPSOAS; TO GREATER TROCHANTER, FEMUR
TRANSFER ILIOPSOAS; TO FEMORAL NECK
ACETABULOPLASTY;
ACETABULOPLASTY; RESECTION, FEMORAL HEAD
HEMIARTHROPLASTY, HIP, PARTIAL
ARTHROPLASTY, ACETABULAR/PROXIMAL FEMORAL PROSTHET
CONVERSION, PREVIOUS HIP SURGERY TO TOTAL HIP ARTH
REVISION, TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS,
REVISION, TOTAL HIP ARTHROPLASTY; ACETABULAR COMPO
REVISION, TOTAL HIP ARTHROPLASTY; FEMORAL COMPONEN
OSTEOTOMY AND TRANSFER, GREATER TROCHANTER, FEMUR
OSTEOTOMY, ILIAC, ACETABULAR/INNOMINATE BONE
OSTEOTOMY, ILIAC, ACETABULAR/INNOMINATE BONE; W/OP
OSTEOTOMY, ILIAC, ACETABULAR/INNOMINATE BONE; W/FE
OSTEOTOMY, ILIAC, ACETABULAR/INNOMINATE BONE; W/FE
OSTEOTOMY, PELVIS, BILAT
OSTEOTOMY, FEMORAL NECK (SEP PROC)
OSTEOTOMY, INTERTROCHANTERIC/SUBTROCHANTERIC W/INT
BONE GRAFT, FEMORAL HEAD, NECK, INTERTROCHANTERIC/
TREATMENT, SLIPPED FEMORAL EPIPHYSIS; TRACTION, W/
TREATMENT, SLIPPED FEMORAL EPIPHYSIS; SINGLE/MULTI
OPEN TREATMENT, SLIPPED FEMORAL EPIPHYSIS; SINGLE/
OPEN TREATMENT, SLIPPED FEMORAL EPIPHYSIS; CLOSED
OPEN TREATMENT, SLIPPED FEMORAL EPIPHYSIS; OSTEOPL
OPEN TREATMENT, SLIPPED FEMORAL EPIPHYSIS; OSTEOTO
EPIPHYSEAL ARREST, EPIPHYSIODESIS/STAPLING, GREATE
PROPHYLACTIC TREATMENT (NAIL/PIN/PLATE/WIRE) W/WO
CLOSED TREATMENT, PELVIC RING FX/DISLOCATION/DIAST
CLOSED TREATMENT, PELVIC RING FX/DISLOCATION/DIAST
CLOSED TREATMENT, COCCYGEAL FX
OPEN TREATMENT, COCCYGEAL FX
OPEN TREATMENT, ILIAC SPINE, TUBEROSITY AVULSION/I
PERCUTANEOUS SKELETAL FIXATION, POSTERIOR PELVIC R
OPEN TREATMENT, ANTERIOR RING FX AND/OR DISLOCATIO
OPEN TREATMENT, POSTERIOR RING FX AND/OR DISLOCATI
CLOSED TREATMENT, ACETABULUM (HIP SOCKET) FX(S); W
CLOSED TREATMENT, ACETABULUM (HIP SOCKET) FX(S); W
OPEN TREATMENT, POSTERIOR/ANTERIOR ACETABULAR WALL
OPEN TREATMENT, ACETABULAR FX INVOLVING ANTERIOR/P
OPEN TREATMENT, ACETABULAR FX INVOLVING ANTERIOR/P
CLOSED TREATMENT, FEMORAL FX, PROXIMAL END, NECK;
CLOSED TREATMENT, FEMORAL FX, PROXIMAL END, NECK;
PERCUTANEOUS SKELETAL FIXATION, FEMORAL FX, PROXIM
OPEN TREATMENT, FEMORAL FX, PROXIMAL END, NECK, IN
CLOSED TREATMENT, INTER/PER/SUBTROCHANTERIC FEMORA
CLOSED TREATMENT, INTER/PER/SUBTROCHANTERIC FEMORA
TREATMENT, INTER/PER/SUBTROCHANTERIC FEMORAL FX; W
OPEN TREATMENT, INTER/PER/SUBTROCHANTERIC FEMORAL
CLOSED TREATMENT, GREATER TROCHANTERIC FX, W/O MAN
OPEN TREATMENT, GREATER TROCHANTERIC FX, W/WO INT/
CLOSED TREATMENT, HIP DISLOCATION, TRAUMATIC; W/O
CLOSED TREATMENT, HIP DISLOCATION, TRAUMATIC; REQU
OPEN TREATMENT, HIP DISLOCATION, TRAUMATIC, W/O IN
OPEN TREATMENT, HIP DISLOCATION, TRAUMATIC, W/ACET
TREATMENT, SPONTANEOUS HIP DISLOCATION, ABDUCTION,
TREATMENT, SPONTANEOUS HIP DISLOCATION, ABDUCTION,
OPEN TREATMENT, SPONTANEOUS HIP DISLOCATION, REPLA
OPEN TREATMENT, SPONTANEOUS HIP DISLOCATION, REPLA
CLOSED TREATMENT, POST HIP ARTHROPLASTY DISLOCATIO
CLOSED TREATMENT, POST HIP ARTHROPLASTY DISLOCATIO
CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END
CLOSED TRMT OF FEMORAL FRACTURE W/MANIPULATION
OPEN TRMT OF FEMORAL FX, PROXIMAL END,HEAD,INCLUDE
MANIPULATION, HIP JOINT, REQUIRING GENERAL ANESTHE
ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS
ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT
ARTHRODESIS, SYMPHYSIS PUBIS (INCLUDING OBTAINING
ARTHRODESIS, HIP JOINT (INCLUDING OBTAINING GRAFT)
ARTHRODESIS, HIP JOINT (INCLUDING OBTAINING GRAFT)
INTERPELVIABDOMINAL AMPUTATION (HINDQUARTER AMPUTA
DISARTICULATION, HIP
UNLISTED PROC, PELVIS/HIP JOINT
INCISION AND DRAINAGE, DEEP ABSCESS, BURSA/HEMATOM
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
27303
27305
27306
27307
27310
27323
27324
27325
27326
27327
27328
27329
27330
27331
27332
27333
27334
27335
27337
27339
27340
27345
27347
27350
27355
27356
27357
27358
27360
27364
27365
27370
27372
27380
27381
27385
27386
27390
27391
27392
27393
27394
27395
27396
27397
27400
27403
27405
27407
27409
27412
27415
27416
27418
27420
27422
27424
27425
27427
27428
27429
27430
27435
27437
27438
27440
27441
27442
27443
27445
27446
27447
27448
27450
27454
27455
27457
27465
27466
27468
27470
27472
27475
27477
27479
27485
27486
27487
27488
27495
27496
INCISION, DEEP, W/OPENING, BONE CORTEX, FEMUR/KNEE
FASCIOTOMY, ILIOTIBIAL (TENOTOMY), OPEN
TENOTOMY, PERCUTANEOUS, ADDUCTOR/HAMSTRING; SINGLE
TENOTOMY, PERCUTANEOUS, ADDUCTOR/HAMSTRING; MULTIP
ARTHROTOMY, KNEE, W/EXPLORATION, DRAINAGE/REMOVAL,
BX, SOFT TISSUE, THIGH/KNEE AREA; SUPERFICIAL
BX, SOFT TISSUE, THIGH/KNEE AREA; DEEP (SUBFASCIAL
Neurectomy, hamstring
Neurectomy, popliteal
EXCISION, TUMOR, THIGH/KNEE AREA; SUBQ
EXCISION, TUMOR, THIGH/KNEE AREA; DEEP/SUBFASCIAL/
RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM
ARTHROTOMY, KNEE; W/SYNOVIAL BX ONLY
ARTHROTOMY, KNEE; W/JOINT EXPLORATION, BX/REMOVAL,
ARTHROTOMY, W/EXCISION, SEMILUNAR CARTILAGE (MENIS
ARTHROTOMY, W/EXCISION, SEMILUNAR CARTILAGE (MENIS
ARTHROTOMY, W/SYNOVECTOMY KNEE; ANTERIOR/POSTERIOR
ARTHROTOMY, W/SYNOVECTOMY KNEE; ANTERIOR AND POSTE
EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3+CM
EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+CM
EXCISION, PREPATELLAR BURSA
EXCISION, SYNOVIAL CYST, POPLITEAL SPACE
EXCISION, LESION, MENISCUS/CAPSULE, KNEE
PATELLECTOMY/HEMIPATELLECTOMY
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, FEMUR
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, FEMUR;
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, FEMUR;
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, FEMUR;
PARTIAL EXCISION, BONE, FEMUR, PROXIMAL TIBIA AND/
RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/>
RADICAL RESECTION, TUMOR, BONE, FEMUR/KNEE
INJECTION KNEE ARTHROGRAPHY
REMOVAL, FB, DEEP, THIGH REGION/KNEE AREA
SUTURE, INFRAPATELLAR TENDON; PRIMARY
SUTURE, INFRAPATELLAR TENDON; SECONDARY RECONSTRUC
SUTURE, QUADRICEPS/HAMSTRING MUSCLE RUPTURE; PRIMA
SUTURE, QUADRICEPS/HAMSTRING MUSCLE RUPTURE; SECON
TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; SINGLE TEN
TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE T
TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE T
LENGTHENING, HAMSTRING TENDON; SINGLE TENDON
LENGTHENING, HAMSTRING TENDON; MULTIPLE TENDONS, O
LENGTHENING, HAMSTRING TENDON; MULTIPLE TENDONS, B
TRANSPLANT, HAMSTRING TENDON TO PATELLA; SINGLE TE
TRANSPLANT, HAMSTRING TENDON TO PATELLA; MULTIPLE
TRANSFER, TENDON/MUSCLE, HAMSTRINGS TO FEMUR
ARTHROTOMY W/MENISCUS REPAIR, KNEE
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNE
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNE
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNE
AUTOLOGOUS CHONDROCYTE IMPLANTATION, KNEE
OSTEOCHONDRAL ALLOGRAFT, KNEE, OPEN
OSTEOCHONDRAL AUTOGRAFT(S), KNEE, OPEN (EG, MOSAIC
ANTERIOR TIBIAL TUBERCLEPLASTY
RECONSTRUCTION, DISLOCATING PATELLA
RECONSTRUCTION, DISLOCATING PATELLA; W/EXTENSOR RE
RECONSTRUCTION, DISLOCATING PATELLA; W/PATELLECTOM
LATERAL RETINACULAR RELEASE, OPEN
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; E
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; I
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; I
QUADRICEPSPLASTY
CAPSULOTOMY, POSTERIOR CAPSULAR RELEASE, KNEE
ARTHROPLASTY, PATELLA; W/O PROSTHESIS
ARTHROPLASTY, PATELLA; W/PROSTHESIS
ARTHROPLASTY, KNEE, TIBIAL PLATEAU
ARTHROPLASTY, KNEE, TIBIAL PLATEAU; W/DEBRIDEMENT
ARTHROPLASTY, FEMORAL CONDYLES/TIBIAL PLATEAU(S),
ARTHROPLASTY, FEMORAL CONDYLES/TIBIAL PLATEAU(S),
ARTHROPLASTY, KNEE, HINGE PROSTHESIS
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL/LA
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AN
OSTEOTOMY, FEMUR, SHAFT/SUPRACONDYLAR; W/O FIXATIO
OSTEOTOMY, FEMUR, SHAFT/SUPRACONDYLAR; W/FIXATION
OSTEOTOMY, MULTIPLE, FEMORAL SHAFT, W/REALIGNMENT
OSTEOTOMY, PROXIMAL TIBIA W/FIBULAR EXCISION/OSTEO
OSTEOTOMY, PROXIMAL TIBIA W/FIBULAR EXCISION/OSTEO
OSTEOPLASTY, FEMUR; SHORTENING (EXCLUDING 64876)
OSTEOPLASTY, FEMUR; LENGTHENING
OSTEOPLASTY, FEMUR; COMBINED, LENGTHENING AND SHOR
REPAIR, NONUNION/MALUNION, FEMUR, DISTAL TO HEAD/N
REPAIR, NONUNION/MALUNION, FEMUR, DISTAL TO HEAD/N
ARREST, EPIPHYSEAL, ANY METHOD; DISTAL FEMUR
ARREST, EPIPHYSEAL, ANY METHOD; TIBIA AND FIBULA,
ARREST, EPIPHYSEAL; COMBINED DISTAL FEMUR/PROXIMAL
ARREST, HEMIEPIPHYSEAL, DISTAL FEMUR/PROXIMAL TIBI
REVISION, TOTAL KNEE ARTHROPLASTY, W/WO ALLOGRAFT;
REVISION, TOTAL KNEE ARTHROPLASTY; FEMORAL AND ENT
REMOVAL, KNEE PROSTHESIS, METHYLMETHACRYLATE W/WO
PROPHYLACTIC TREATMENT (NAIL/PIN/PLATE/WIRE), FEMU
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, 1 COM
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2005
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
27497
27498
27499
27500
27501
27502
27503
27506
27507
27508
27509
27510
27511
27513
27514
27516
27517
27519
27520
27524
27530
27532
27535
27536
27538
27540
27550
27552
27556
27557
27558
27560
27562
27566
27570
27580
27590
27591
27592
27594
27596
27598
27599
27600
27601
27602
27603
27604
27605
27606
27607
27610
27612
27613
27614
27615
27616
27618
27619
27620
27625
27626
27630
27632
27634
27635
27637
27638
27640
27641
27645
27646
27647
27648
27650
27652
27654
27656
27658
27659
27664
27665
27675
27676
27680
27681
27685
27686
27687
27690
27691
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, 1 COM
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTI
DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTI
CLOSED TREATMENT, FEMORAL SHAFT FX, W/O MANIPULATI
CLOSED TREATMENT, SUPRACONDYLAR/TRANSCONDYLAR FEMO
CLOSED TREATMENT, FEMORAL SHAFT FX, W/MANIPULATION
CLOSED TREATMENT, SUPRACONDYLAR/TRANSCONDYLAR FEMO
OPEN TREATMENT, FEMORAL SHAFT FX, W/INSERTION, INT
OPEN TREATMENT, FEMORAL SHAFT FX W/PLATE/SCREWS, W
CLOSED TREATMENT, FEMORAL FX, DISTAL END, MEDIAL/L
PERCUTANEOUS SKELETAL FIXATION, FEMORAL FX, DISTAL
CLOSED TREATMENT, FEMORAL FX, DISTAL END, MEDIAL/L
OPEN TREATMENT, FEMORAL SUPRACONDYLAR/TRANSCONDYLA
OPEN TREATMENT, FEMORAL SUPRACONDYLAR/TRANSCONDYLA
OPEN TREATMENT, FEMORAL FX, DISTAL END, MEDIAL/LAT
CLOSED TREATMENT, DISTAL FEMORAL EPIPHYSEAL SEPARA
CLOSED TREATMENT, DISTAL FEMORAL EPIPHYSEAL SEPARA
OPEN TREATMENT, DISTAL FEMORAL EPIPHYSEAL SEPARATI
CLOSED TREATMENT, PATELLAR FX, W/O MANIPULATION
OPEN TREATMENT, PATELLAR FX, W/INT FIXATION/PATELL
CLOSED TREATMENT, TIBIAL FX, PROXIMAL; W/O MANIPUL
CLOSED TREATMENT, TIBIAL FX, PROXIMAL; W/WO MANIPU
OPEN TREATMENT, TIBIAL FX, PROXIMAL; UNICONDYLAR,
OPEN TREATMENT, TIBIAL FX, PROXIMAL; BICONDYLAR, W
CLOSED TREATMENT, INTERCONDYLAR SPINE/TUBEROSITY F
OPEN TREATMENT, INTERCONDYLAR SPINE/TUBEROSITY FX,
CLOSED TREATMENT, KNEE DISLOCATION; W/O ANESTHESIA
CLOSED TREATMENT, KNEE DISLOCATION; REQUIRING ANES
OPEN TREATMENT, KNEE DISLOCATION W/WO INT/EXT FIX;
OPEN TREATMENT, KNEE DISLOCATION, W/WO INT/EXT FIX
OPEN TREATMENT, KNEE DISLOCATION, W/WO INT/EXT FIX
CLOSED TREATMENT, PATELLAR DISLOCATION; W/O ANESTH
CLOSED TREATMENT, PATELLAR DISLOCATION; REQUIRING
OPEN TREATMENT, PATELLAR DISLOCATION, W/WO PARTIAL
MANIPULATION, KNEE JOINT UNDER GENERAL ANESTHESIA
ARTHRODESIS, KNEE, ANY TECHNIQUE
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL;
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; IMMED
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; OPEN,
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; SECON
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; RE-AM
DISARTICULATION AT KNEE
UNLISTED PROC, FEMUR/KNEE
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LAT
DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTME
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LAT
INCISION AND DRAINAGE, LEG/ANKLE; DEEP ABSCESS/HEM
INCISION AND DRAINAGE, LEG/ANKLE; INFECTED BURSA
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEP PROC)
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEP PROC)
INCISION, LEG/ANKLE
ARTHROTOMY, ANKLE, W/EXPLORATION, DRAINAGE/REMOVAL
ARTHROTOMY, POSTERIOR CAPSULAR RELEASE, ANKLE, W/W
BX, SOFT TISSUE, LEG/ANKLE AREA; SUPERFICIAL
BX, SOFT TISSUE, LEG/ANKLE AREA; DEEP (SUBFASCIAL/
RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE <5CM
RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/>
EXCISION, TUMOR, LEG/ANKLE AREA; SUBQ TISSUE
EXCISION, TUMOR, LEG/ANKLE AREA; DEEP (SUBFASCIAL/
ARTHROTOMY, ANKLE, W/JOINT EXPLORATION W/WO BX/REM
ARTHROTOMY, W/SYNOVECTOMY, ANKLE;
ARTHROTOMY, W/SYNOVECTOMY, ANKLE; W/TENOSYNOVECTOM
EXCISION, LESION, TENDON SHEATH/CAPSULE, LEG AND/O
EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3+CM
EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, TIBIA/
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, TIBIA/
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, TIBIA/
PARTIAL EXCISION, BONE; TIBIA
PARTIAL EXCISION, BONE; FIBULA
RADICAL RESECTION OF TUMOR TIBIA
RADICAL RESECTION, TUMOR, BONE; FIBULA
RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS
INJECTION PROC, ANKLE ARTHROGRAPHY
REPAIR, PRIMARY, OPEN/PERCUTANEOUS, RUPTURED ACHIL
REPAIR, PRIMARY, OPEN/PERCUTANEOUS, RUPTURED ACHIL
REPAIR, SECONDARY, ACHILLES TENDON, W/WO GRAFT
REPAIR, FASCIAL DEFECT, LEG
REPAIR, FLEXOR TENDON, LEG; PRIMARY, W/O GRAFT, EA
REPAIR, FLEXOR TENDON, LEG; SECONDARY, W/WO GRAFT,
REPAIR, EXTENSOR TENDON, LEG; PRIMARY, W/O GRAFT,
REPAIR, EXTENSOR TENDON, LEG; SECONDARY, W/WO GRAF
REPAIR, DISLOCATING PERONEAL TENDONS; W/O FIBULAR
REPAIR, DISLOCATING PERONEAL TENDONS; W/FIBULAR OS
TENOLYSIS, FLEXOR/EXTENSOR TENDON, LEG AND/OR ANKL
TENOLYSIS, FLEXOR/EXTENSOR TENDON, LEG AND/OR ANKL
LENGTHENING/SHORTENING, TENDON, LEG/ANKLE; SINGLE
LENGTHENING/SHORTENING, TENDON, LEG/ANKLE; MULTIPL
GASTROCNEMIUS RECESSION
TRANSFER/TRANSPLANT, SINGLE TENDON; SUPERFICIAL
TRANSFER/TRANSPLANT, SINGLE TENDON; DEEP
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
27692
27695
27696
27698
27700
27702
27703
27704
27705
27707
27709
27712
27715
27720
27722
27724
27725
27726
27727
27730
27732
27734
27740
27742
27745
27750
27752
27756
27758
27759
27760
27762
27766
27767
27768
27769
27780
27781
27784
27786
27788
27792
27808
27810
27814
27816
27818
27822
27823
27824
27825
27826
27827
27828
27829
27830
27831
27832
27840
27842
27846
27848
27860
27870
27871
27880
27881
27882
27884
27886
27888
27889
27892
27893
27894
27899
28001
28002
28003
28005
28008
28010
28011
28020
28022
28024
28035
28039
28041
28043
28045
TRANSFER/TRANSPLANT, SINGLE TENDON; ADDL TENDON
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLAT
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; BOTH C
REPAIR, SECONDARY DISRUPTED LIGAMENT, ANKLE, COLLA
ARTHROPLASTY, ANKLE;
ARTHROPLASTY, ANKLE; W/IMPLANT (TOTAL ANKLE)
ARTHROPLASTY, ANKLE; REVISION, TOTAL ANKLE
REMOVAL, ANKLE IMPLANT
OSTEOTOMY; TIBIA
OSTEOTOMY; FIBULA
OSTEOTOMY; TIBIA AND FIBULA
OSTEOTOMY; MULTIPLE, W/REALIGNMENT ON INTRAMEDULLA
OSTEOPLASTY, TIBIA AND FIBULA, LENGTHENING/SHORTEN
REPAIR, NONUNION/MALUNION, TIBIA; W/O GRAFT
REPAIR, NONUNION/MALUNION, TIBIA; W/SLIDING GRAFT
REPAIR, NONUNION/MALUNION, TIBIA; W/ILIAC/OTHER AU
REPAIR, NONUNION/MALUNION, TIBIA; SYNOSTOSIS, W/FI
REPAIR OF FIBULA NONUNION AND/OR MALUNION W/INT FI
REPAIR, CONGENITAL PSEUDARTHROSIS, TIBIA
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL
ARREST, EPIPHYSEAL, COMBINED, PROXIMAL/DISTAL TIBI
ARREST, EPIPHYSEAL, COMBINED, PROXIMAL/DISTAL TIBI
PROPHYLACTIC TREATMENT, TIBIA, W/WO METHYLMETHACRY
CLOSED TREATMENT, TIBIAL SHAFT FX; W/O MANIPULATIO
CLOSED TREATMENT, TIBIAL SHAFT FX; W/MANIPULATION,
PERCUTANEOUS SKELETAL FIXATION, TIBIAL SHAFT FX
OPEN TREATMENT, TIBIAL SHAFT FX, W/PLATE/SCREWS, W
TREATMENT, TIBIAL SHAFT FX, INTRAMEDULLARY IMPLANT
CLOSED TREATMENT, MEDIAL MALLEOLUS FX; W/O MANIPUL
CLOSED TREATMENT, MEDIAL MALLEOLUS FX; W/MANIPULAT
OPEN TREATMENT, MEDIAL MALLEOLUS FX, W/WO INT/EXT
CLOSED TREATMENT OF POSTERIOR MALLEOLUS FX, W/O MA
CLOSED TREATMENT OF POSTERIOR MALLEOLUS FX W/MANIP
OPEN TRMNT OF POSTERIOR MALLEOLUS FX, INC INTERN
CLOSED TREATMENT, PROXIMAL FIBULA/SHAFT FX; W/O MA
CLOSED TREATMENT, PROXIMAL FIBULA/SHAFT FX; W/MANI
OPEN TREATMENT, PROXIMAL FIBULA/SHAFT FX, W/WO INT
CLOSED TREATMENT, DISTAL FIBULAR FX (LATERAL MALLE
CLOSED TREATMENT, DISTAL FIBULAR FX (LATERAL MALLE
OPEN TREATMENT, DISTAL FIBULAR FX, W/WO INT/EXT FI
CLOSED TREATMENT, BIMALLEOLAR ANKLE FX, (W/POTTS);
CLOSED TREATMENT, BIMALLEOLAR ANKLE FX, (W/POTTS);
OPEN TREATMENT, BIMALLEOLAR ANKLE FX, W/WO INT/EXT
CLOSED TREATMENT, TRIMALLEOLAR ANKLE FX; W/O MANIP
CLOSED TREATMENT, TRIMALLEOLAR ANKLE FX; W/MANIPUL
OPEN TREATMENT, TRIMALLEOLAR ANKLE FX, MEDIAL/LATE
OPEN TREATMENT, TRIMALLEOLAR ANKLE FX, MEDIAL/LATE
CLOSED TREATMENT, FX, WT BEARING ARTICULAR PORTION
CLOSED TREATMENT, FX, WT BEARING ARTICULAR PORTION
OPEN TREATMENT, FX, WT BEARING ARTICULAR SURFACE/P
OPEN TREATMENT, FX, WT BEARING ARTICULAR SURFACE/P
OPEN TREATMENT, FX, WT BEARING ARTICULAR SURFACE/P
OPEN TREATMENT, DISTAL TIBIOFIBULAR JOINT DISRUPTI
CLOSED TREATMENT, PROXIMAL TIBIOFIBULAR JOINT DISL
CLOSED TREATMENT, PROXIMAL TIBIOFIBULAR JOINT DISL
OPEN TREATMENT, PROXIMAL TIBIOFIBULAR JOINT DISLOC
CLOSED TREATMENT, ANKLE DISLOCATION; W/O ANESTHESI
CLOSED TREATMENT, ANKLE DISLOCATION; W/ANESTHESIA,
OPEN TREATMENT, ANKLE DISLOCATION W/WO PERC SKELET
OPEN TREATMENT, ANKLE DISLOCATION W/WO PERC SKELET
MANIPULATION, ANKLE UNDER GENERAL ANESTHESIA
ARTHRODESIS, ANKLE, OPEN
ARTHRODESIS, TIBIOFIBULAR JOINT, PROXIMAL/DISTAL
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA;
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; W/IMMED
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; OPEN, C
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; SECONDA
AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; RE-AMPU
AMPUTATION, ANKLE-MALLEOLI, TIBIA/FIBULA, W/PLASTI
ANKLE DISARTICULATION
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR/LATERAL CO
DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTME
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR/LATERAL/PO
UNLISTED PROC, LEG/ANKLE
INCISION AND DRAINAGE, BURSA, FOOT
INCISION AND DRAINAGE BELOW FASCIA, W/WO TENDON SH
INCISION AND DRAINAGE BELOW FASCIA, W/WO TENDON SH
INCISION, BONE CORTEX, FOOT
FASCIOTOMY, FOOT AND/OR TOE
TENOTOMY, PERCUTANEOUS, TOE; SINGLE TENDON
TENOTOMY, PERCUTANEOUS, TOE; MULTIPLE TENDONS
ARTHROTOMY, W/EXPLORATION/DRAINAGE/REMOVAL LOOSE/F
ARTHROTOMY, W/EXPLORATION/DRAINAGE/REMOVAL LOOSE/F
ARTHROTOMY, W/EXPLORATION/DRAINAGE/REMOVAL LOOSE/F
RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DEC
EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ 1.5+CM
EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM
EXCISION, TUMOR, FOOT; SUBQ TISSUE
EXCISION, TUMOR, FOOT; DEEP, SUBFASCIAL, IM
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
28046
28047
28050
28052
28054
28055
28060
28062
28070
28072
28080
28086
28088
28090
28092
28100
28102
28103
28104
28106
28107
28108
28110
28111
28112
28113
28114
28116
28118
28119
28120
28122
28124
28126
28130
28140
28150
28153
28160
28171
28173
28175
28190
28192
28193
28200
28202
28208
28210
28220
28222
28225
28226
28230
28232
28234
28238
28240
28250
28260
28261
28262
28264
28270
28272
28280
28285
28286
28288
28289
28290
28292
28293
28294
28296
28297
28298
28299
28300
28302
28304
28305
28306
28307
28308
28309
28310
28312
28313
28315
28320
RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM
RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE 3 CM/>
ARTHROTOMY W/BX; INTERTARSAL/TARSOMETATARSAL JOINT
ARTHROTOMY W/BX; METATARSOPHALANGEAL JOINT
ARTHROTOMY W/BX; INTERPHALANGEAL JOINT
Neurectomy, foot
FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEP PROC)
FASCIECTOMY, PLANTAR FASCIA; RADICAL (SEP PROC)
SYNOVECTOMY; INTERTARSAL/TARSOMETATARSAL JOINT, EA
SYNOVECTOMY; METATARSOPHALANGEAL JOINT, EACH
EXCISION, INTERDIGITAL (MORTON) NEUROMA, SINGLE, E
SYNOVECTOMY, TENDON SHEATH, FOOT; FLEXOR
SYNOVECTOMY, TENDON SHEATH, FOOT; EXTENSOR
EXCISION, LESION, TENDON SHEATH/CAPSULE; FOOT
EXCISION, LESION, TENDON SHEATH/CAPSULE; TOES, EAC
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, TALUS/
EXCISION/ CURETTAGE, BONE CYST/BENIGN TUMOR, TALUS
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, TALUS/
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, TARSAL
EXCISN/CURET, BONE CYST/BENIGN TUMOR, TARSAL/METAT
EXCISN/CURETTAGE, BONE CYST/BENIGN TUMOR, TARSAL/M
EXCISION/CURETTAGE, BONE CYST/BENIGN TUMOR, PHALAN
OSTECTOMY, PARTIAL EXCISION, 5TH METATARSAL HEAD (
OSTECTOMY, COMPLETE EXCISION; 1ST METATARSAL HEAD
OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEA
OSTECTOMY, COMPLETE EXCISION; 5TH METATARSAL HEAD
OSTECTOMY, COMPLETE EXCISN; ALL METATARSAL HEADS,
OSTECTOMY, EXCISION, TARSAL COALITION
OSTECTOMY, CALCANEUS;
OSTECTOMY, CALCANEUS; SPUR, W/WO PLANTAR FASCIAL R
PARTIAL EXCISION, BONE; TALUS/CALCANEUS
PARTIAL EXCISION, BONE; TARSAL/METATARSAL BONE, NO
PARTIAL EXCISION, BONE; PHALANX, TOE
RESECTION, PARTIAL/COMPLETE, PHALANGEAL BASE, EACH
TALECTOMY (ASTRAGALECTOMY)
METATARSECTOMY
PHALANGECTOMY, TOE, EACH TOE
RESECTION, CONDYLE(S), DISTAL END, PHALANX, EACH T
HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXCISION,
RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS
RADICAL RESECTION TUMOR METATARSAL
RADICAL RESECTION TUMOR PHALANX OR TOE
REMOVAL, FB, FOOT; SUBQ
REMOVAL, FB, FOOT; DEEP
REMOVAL, FB, FOOT; COMPLICATED
REPAIR, TENDON, FLEXOR, FOOT; PRIMARY/SECONDARY, W
REPAIR, TENDON, FLEXOR, FOOT; SECONDARY W/FREE GRA
REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY/SECONDARY,
REPAIR, TENDON, EXTENSOR, FOOT; SECONDARY W/FREE G
TENOLYSIS, FLEXOR, FOOT; SINGLE TENDON
TENOLYSIS, FLEXOR, FOOT; MULTIPLE TENDONS
TENOLYSIS, EXTENSOR, FOOT; SINGLE TENDON
TENOLYSIS, EXTENSOR, FOOT; MULTIPLE TENDONS
TENOTOMY, OPEN, TENDON FLEXOR; FOOT, SINGLE/MULTIP
TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON
TENOTOMY, OPEN, EXTENSOR, FOOT/TOE, EACH TENDON
RECONSTRUCTION, POSTERIOR TIBIAL TENDON, EXCISION,
TENOTOMY, LENGTHENING/RELEASE, ABDUCTOR HALLUCIS M
DIVISION, PLANTAR FASCIA AND MUSCLE (SEP PROC)
CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEP PRO
CAPSULOTOMY, MIDFOOT; W/TENDON LENGTHENING
CAPSULOTOMY, MIDFOOT; EXTENSIVE, INC POST TALOTIBI
CAPSULOTOMY, MIDTARSAL
CAPSULOTOMY; METATARSOPHALANGEAL JOINT, W/WO TENOR
CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT (SE
SYNDACTYLIZATION, TOES
CORRECTION, HAMMERTOE
CORRECTION, COCK-UP FIFTH TOE, W/PLASTIC SKIN CLOS
OSTECTOMY, PARTIAL, EXOSTECTOMY/CONDYLECTOMY, META
HALLUX RIGIDUS CORRECTION, W/CHEILECTOMY, DEBRIDEM
HALLUX VALGUS CORRECTION, W/WO SESAMOIDECTOMY; SIM
HALLUX VALGUS CORRECTION, W/WO SESAMOIDECTOMY; KEL
HALLUX VALGUS CORRECTION, W/WO SESAMOIDECTOMY; RES
HALLUX VALGUS CORRECTION, W/WO SESAMOIDECTOMY; W/T
HALLUX VALGUS CORRECTION, W/WO SESAMOIDECTOMY; W/M
HALLUX VALGUS CORRECTION, W/WO SESAMOIDECTOMY; LAP
HALLUX VALGUS CORRECTION, W/WO SESAMOIDECTOMY; PHA
HALLUX VALGUS CORRECTION; DOUBLE OSTEOTOMY
OSTEOTOMY; CALCANEUS, W/WO INT FIXATION
OSTEOTOMY; TALUS
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS/TALU
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS/TALU
OSTEOTOMY, METATARSAL, W/WO LENGTHENING/SHORTENING
OSTEOTOMY, METATARSAL, W/WO LENGTHENING/SHORTENING
OSTEOTOMY, METATARSAL, W/WO LENGTHENING/SHORTENING
OSTEOTOMY, METATARSAL, W/WO LENGTHENING/SHORTENING
OSTEOTOMY, SHORTENING, ANGULAR/ROTATIONAL CORRECTI
OSTEOTOMY, SHORTENING, ANGULAR/ROTATIONAL CORRECTI
RECONSTRUCTION, ANGULAR DEFORMITY, TOE, SOFT TISSU
SESAMOIDECTOMY, 1ST TOE (SEP PROC)
REPAIR, NONUNION/MALUNION; TARSAL BONES
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
28322
28340
28341
28344
28345
28360
28400
28405
28406
28415
28420
28430
28435
28436
28445
28446
28450
28455
28456
28465
28470
28475
28476
28485
28490
28495
28496
28505
28510
28515
28525
28530
28531
28540
28545
28546
28555
28570
28575
28576
28585
28600
28605
28606
28615
28630
28635
28636
28645
28660
28665
28666
28675
28705
28715
28725
28730
28735
28737
28740
28750
28755
28760
28800
28805
28810
28820
28825
28890
28899
29000
29010
29015
29035
29040
29044
29046
29049
29055
29058
29065
29075
29085
29086
29105
29125
29126
29130
29131
29200
29240
REPAIR, NONUNION/MALUNION; METATARSAL, W/WO BONE G
RECONSTRUCTION, TOE, MACRODACTYLY; SOFT TISSUE RES
RECONSTRUCTION, TOE, MACRODACTYLY; REQUIRING BONE
RECONSTRUCTION, TOE(S); POLYDACTYLY
RECONSTRUCTION, TOE(S); SYNDACTYLY, W/WO SKIN GRAF
RECONSTRUCTION, CLEFT FOOT
CLOSED TREATMENT, CALCANEAL FX; W/O MANIPULATION
CLOSED TREATMENT, CALCANEAL FX; W/MANIPULATION
PERCUTANEOUS SKELETAL FIXATION, CALCANEAL FX, W/MA
OPEN TREATMENT, CALCANEAL FX, W/WO INT/EXT FIXATIO
OPEN TREATMENT, CALCANEAL FX, W/WO INT/EXT FIXATIO
CLOSED TREATMENT, TALUS FX; W/O MANIPULATION
CLOSED TREATMENT, TALUS FX; W/MANIPULATION
PERCUTANEOUS SKELETAL FIXATION, TALUS FX, W/MANIPU
OPEN TREATMENT, TALUS FX, W/WO INT/EXT FIXATION
OPEN OSTEOCHONDRAL AUTOGRAFT, TALUS(INCL OBTAINING
TREATMENT, TARSAL BONE FX (EXCEPT TALUS AND CALCAN
TREATMENT, TARSAL BONE FX (EXCEPT TALUS AND CALCAN
PERCUTANEOUS SKELETAL FIXATION, TARSAL FX, W/MANIP
OPEN TREATMENT, TARSAL FX, W/WO INT/EXT FIXATION,
CLOSED TREATMENT, METATARSAL FX; W/O MANIPULATION,
CLOSED TREATMENT, METATARSAL FX; W/MANIPULATION, E
PERCUTANEOUS SKELETAL FIXATION, METATARSAL FX, W/M
OPEN TREATMENT, METATARSAL FX, W/WO INT/EXT FIXATI
CLOSED TREATMENT, FX GREAT TOE, PHALANX/PHALANGES;
CLOSED TREATMENT, FX GREAT TOE, PHALANX/PHALANGES;
PERCUTANEOUS SKELETAL FIXATION, FX GREAT TOE, PHAL
OPEN TREATMENT, FX GREAT TOE, PHALANX/PHALANGES W/
CLOSED TREATMENT, FX, PHALANX/PHALANGES, NOT GREAT
CLOSED TREATMENT, FX, PHALANX/PHALANGES, NOT GREAT
OPEN TREATMENT, FX, PHALANX/PHALANGES, NOT GREAT T
CLOSED TREATMENT, SESAMOID FX
OPEN TREATMENT, SESAMOID FX, W/WO INT FIXATION
CLOSED TREATMENT, TARSAL BONE DISLOCATION, OTHER T
CLOSED TREATMENT, TARSAL BONE DISLOCATION, OTHER T
PERCUTANEOUS SKELETAL FIXATION, TARSAL DISLOCATION
OPEN TREATMENT, TARSAL BONE DISLOCATION, W/WO INT/
CLOSED TREATMENT, TALOTARSAL JOINT DISLOCATION; W/
CLOSED TREATMENT, TALOTARSAL JOINT DISLOCATION; RE
PERCUTANEOUS SKELETAL FIXATION, TALOTARSAL JOINT D
OPEN TREATMENT, TALOTARSAL JOINT DISLOCATION, W/WO
CLOSED TREATMENT, TARSOMETATARSAL JOINT DISLOCATIO
CLOSED TREATMENT, TARSOMETATARSAL JOINT DISLOCATIO
PERCUTANEOUS SKELETAL FIXATION, TARSOMETATARSAL JO
OPEN TREATMENT, TARSOMETATARSAL JOINT DISLOCATION
CLOSED TREATMENT, METATARSOPHALANGEAL JOINT DISLOC
CLOSED TREATMENT, METATARSOPHALANGEAL JOINT DISLOC
PERCUTANEOUS SKELETAL FIXATION, METATARSOPHALANGEA
OPEN TREATMENT, METATARSOPHALANGEAL JOINT DISLOCAT
CLOSED TREATMENT, INTERPHALANGEAL JOINT DISLOCATIO
CLOSED TREATMENT, INTERPHALANGEAL JOINT DISLOCATIO
PERCUTANEOUS SKELETAL FIXATION, INTERPHALANGEAL JO
OPEN TREATMENT, INTERPHALANGEAL JOINT DISLOCATION
ARTHRODESIS; PANTALAR
ARTHRODESIS; TRIPLE
ARTHRODESIS; SUBTALAR
ARTHRODESIS, MIDTARSAL/TARSOMETATARSAL, MULTIPLE/T
ARTHRODESIS, MIDTARSAL/TARSOMETATARSAL, MULTIPLE/T
ARTHRODESIS, W/TENDON LENGTHENING/ADVANCEMENT, MID
ARTHRODESIS, MIDTARSAL/TARSOMETATARSAL, SINGLE JOI
ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT
ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT
ARTHRODESIS, GREAT TOE, INTERPHALANGEAL, W/EXTENSO
AMPUTATION, FOOT; MIDTARSAL
AMPUTATION, FOOT; TRANSMETATARSAL
AMPUTATION, METATARSAL, W/TOE, SINGLE
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
AMPUTATION, TOE; INTERPHALANGEAL JOINT
ESWT HI NRG PHYS/QHP W/US GDN INVG PLNTAR FASCIA
UNLISTED PROC, FOOT/TOES
APPLICATION, HALO TYPE BODY CAST (SEE 20661-20663,
APPLICATION, RISSER JACKET, LOCALIZER, BODY; ONLY
APPLICATION, RISSER JACKET, LOCALIZER, BODY; W/HEA
APPLICATION, BODY CAST, SHOULDER TO HIPS;
APPLICATION, BODY CAST, SHOULDER TO HIPS; W/HEAD,
APPLICATION, BODY CAST, SHOULDER TO HIPS; W/ONE TH
APPLICATION, BODY CAST, SHOULDER TO HIPS; W/BOTH T
APPLICATION, CAST; FIGURE-OF-EIGHT
APPLICATION, CAST; SHOULDER SPICA
APPLICATION, CAST; PLASTER VELPEAU
APPLICATION, CAST; SHOULDER TO HAND (LONG ARM)
APPLICATION, CAST; ELBOW TO FINGER (SHORT ARM)
APPLICATION, CAST; HAND AND LOWER FOREARM (GAUNTLE
APPLICATION, CAST; FINGER (CONTRACTURE)
APPLICATION, LONG ARM SPLINT (SHOULDER TO HAND)
APPLICATION, SHORT ARM SPLINT (FOREARM TO HAND); S
APPLICATION, SHORT ARM SPLINT (FOREARM TO HAND); D
APPLICATION, FINGER SPLINT; STATIC
APPLICATION, FINGER SPLINT; DYNAMIC
STRAPPING; THORAX
STRAPPING; SHOULDER (VELPEAU)
1/1/2004
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1/1/2004
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1/1/2008
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1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
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1/1/2004
1/1/2004
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1/1/2004
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1/1/2004
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1/1/2004
1/1/2004
1/1/2004
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1/1/2004
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1/1/2004
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1/1/2004
1/1/2004
1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
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12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
29260
29280
29305
29325
29345
29355
29358
29365
29405
29425
29435
29440
29445
29450
29505
29515
29520
29530
29540
29550
29580
29581
29582
29583
29584
29700
29705
29710
29720
29730
29740
29750
29799
29800
29804
29805
29806
29807
29819
29820
29821
29822
29823
29824
29825
29826
29827
29828
29830
29834
29835
29836
29837
29838
29840
29843
29844
29845
29846
29847
29848
29850
29851
29855
29856
29860
29861
29862
29863
29866
29867
29868
29870
29871
29873
29874
29875
29876
29877
29879
29880
29881
29882
29883
29884
29885
29886
29887
29888
29889
29891
STRAPPING; ELBOW/WRIST
STRAPPING; HAND/FINGER
APPLICATION, HIP SPICA CAST; ONE LEG
APPLICATION, HIP SPICA CAST; ONE AND ONE-HALF SPIC
APPLICATION, LONG LEG CAST (THIGH TO TOES);
APPLICATION, LONG LEG CAST (THIGH TO TOES); WALKER
APPLICATION, LONG LEG CAST BRACE
APPLICATION, CYLINDER CAST (THIGH TO ANKLE)
APPLICATION, SHORT LEG CAST (BELOW KNEE TO TOES);
APPLICATION, SHORT LEG CAST (BELOW KNEE TO TOES);
APPLICATION, PATELLAR TENDON BEARING CAST
ADDING WALKER TO PREVIOUSLY APPLIED CAST
APPLICATION, RIGID TOTAL CONTACT LEG CAST
APPLICATION, CLUBFOOT CAST W/MOLDING/MANIPULATION,
APPLICATION, LONG LEG SPLINT (THIGH TO ANKLE/TOES)
APPLICATION, SHORT LEG SPLINT (CALF TO FOOT)
STRAPPING; HIP
STRAPPING; KNEE
STRAPPING; ANKLE AND/OR FOOT
STRAPPING; TOES
STRAPPING; UNNA BOOT
APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT
APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE
APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM
APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FINGER
REMOVAL/BIVALVING; GAUNTLET, BOOT/BODY CAST
REMOVAL/BIVALVING; FULL ARM/FULL LEG CAST
REMOVAL/BIVALVING; SHOULDER/HIP SPICA, MINERVA/RIS
REPAIR, SPICA, BODY CAST/JACKET
WINDOWING, CAST
WEDGING, CAST (EXCEPT CLUBFOOT CASTS)
WEDGING, CLUBFOOT CAST
UNLISTED PROC, CASTING/STRAPPING
ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, DX W/WO SYNO
ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, SURGICAL
ARTHROSCOPY, SHOULDER, DX, W/WO SYNOVIAL BX (SEP P
ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY
ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR, SLAP LESI
ARTHROSCOPY, SHOULDER, SURGICAL; W/REMOVAL, LOOSE/
ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PART
ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMP
ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMI
ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTE
ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULEC
ARTHROSCOPY, SHOULDER, SURGICAL; W/LYSIS AND RESEC
SHOULDER SCOPE BONE SHAVING
ARTHROSCOPY, SHOULDER, SURGICAL; W/ROTATOR CUFF RE
ARTHROSCOPY SHOULDER SURGICAL BICEPS TENODESIS
ARTHROSCOPY, ELBOW, DX, W/WO SYNOVIAL BX (SEP PROC
ARTHROSCOPY, ELBOW, SURGICAL; W/REMOVAL, LOOSE/FOR
ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, PARTIAL
ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, COMPLET
ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED
ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, EXTENSI
ARTHROSCOPY, WRIST, DX, W/WO SYNOVIAL BX (SEP PROC
ARTHROSCOPY, WRIST, SURGICAL; INFECTION, LAVAGE AN
ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, PARTIAL
ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, COMPLET
ARTHROSCOPY, WRIST, SURGICAL; EXCISION/REPAIR, TRI
ARTHROSCOPY, WRIST, SURGICAL; INT FIXATION, FX/INS
ENDOSCOPY, WRIST, SURGICAL, W/RELEASE, TRANSVERSE
ARTHROSCOPICALLY AIDED TREATMENT, FX, KNEE W/WO MA
ARTHROSCOPICALLY AIDED TREATMENT, FX, KNEE W/WO MA
ARTHROSCOPICALLY AIDED TREATMENT, TIBIAL FX, PROXI
ARTHROSCOPICALLY AIDED TREATMENT, TIBIAL FX, PROXI
ARTHROSCOPY, HIP, DX W/WO SYNOVIAL BX (SEP PROC)
ARTHROSCOPY, HIP, SURGICAL; W/REMOVAL, LOOSE/FOREI
ARTHROSCOPY, HIP, SURGICAL; W/CHONDROPLASTY/ARTHRO
ARTHROSCOPY, HIP, SURGICAL; W/SYNOVECTOMY
ARTHOSCOPY, KNEE, SURGICAL, OSTEOCHONDRAL AUTOGRAP
ARTHOSCOPY, KNEE, SURGICAL, OSTEPCJRPMDRA; ALLOGRA
ARTHOSCOPY, KNEE, SURGICAL, MENISCAL TRANSPLANTATI
ARTHROSCOPY, KNEE, DX, W/WO SYNOVIAL BX (SEP PROC)
ARTHROSCOPY, KNEE, SURGICAL; INFECTION, LAVAGE AND
ARTHROSCOPY, KNEE, SURGICAL; W/LATERAL RELEASE
ARTHROSCOPY, KNEE, SURGICAL; REMOVAL, LOOSE/FB
ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED
ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, O
ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING,
ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY
ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING
ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG
ARTHROSCOPY, KNEE, SURGICAL; W/MENISCUS REPAIR, ME
ARTHROSCOPY, KNEE, SURGICAL; W/MENISCUS REPAIR, ME
ARTHROSCOPY, KNEE, SURGICAL; W/LYSIS, ADHESIONS, W
ARTHROSCOPY, KNEE, SURGICAL; DRILL, OSTEOCHONDRITI
ARTHROSCOPY, KNEE, SURGICAL; DRILLING, INTACT OSTE
ARTHROSCOPY, KNEE, SURGICAL; DRILLING, INTACT OSTE
ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT
ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT
ARTHROSCOPY, ANKLE, SURGICAL; EXCISION OSTEOCHONDR
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2005
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
29892
29893
29894
29895
29897
29898
29899
29900
29901
29902
29904
29905
29906
29907
29914
29915
29916
29999
30000
30020
3006F
3008F
30100
30110
30115
30117
30118
3011F
30120
30124
30125
30130
30140
3014F
30150
3015F
30160
3016F
3017F
3018F
3019F
30200
3020F
30210
3021F
30220
3022F
3023F
3025F
3027F
3028F
30300
30310
30320
3035F
3037F
3038F
30400
3040F
30410
30420
3042F
30430
30435
3044F
30450
3045F
30460
30462
30465
3046F
3048F
3049F
3050F
30520
30540
30545
3055F
30560
3056F
30580
30600
3060F
3061F
30620
3062F
30630
3066F
3072F
3073F
3074F
ARTHROSCOPICALLY AIDED REPAIR, OSTEOCHONDRITIS/TAL
ENDOSCOPIC PLANTAR FASCIOTOMY
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOI
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOI
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOI
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOI
ARTHROSCOPY, ANKLE, SURGICAL; W/ANKLE ARTHRODESIS
ARTHROSCOPY, METACARPOPHALANGEAL JOINT, DIAGNOSTIC
ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL;
ARTHROSCOPY, METACARPOPHALANGEAL JOINT, SURGICAL;
ARTHROSCOPY SUBTALAR JOINT, SURG, W/REMOVAL LOOSE
ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY
ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT
ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS
ARTHROSCOPY HIP W/FEMOROPLASTY
ARTHROSCOPY HIP W/ACETABULOPLASTY
ARTHROSCOPY HIP W/LABRAL REPAIR
UNLISTED PROC, ARTHROSCOPY
DRAINAGE ABSCESS/HEMATOMA, NASAL, INT APPROACH
DRAINAGE ABSCESS/HEMATOMA, NASAL SEPTUM
Cxr doc rev
BODY MASS INDEX (BMI) DOCUMENTED
BX, INTRANASAL
EXCISION, NASAL POLYP(S), SIMPLE
EXCISION, NASAL POLYP(S), EXTENSIVE
EXCISION/DESTRUCTION, INTRANASAL LESION; INT APPRO
EXCISION/DESTRUCTION, INTRANASAL LESION; EXT APPRO
Lipid panel doc rev
EXCISION/SURGICAL PLANING, SKIN, NOSE, RHINOPHYMA
EXCISION DERMOID CYST, NOSE; SIMPLE, SKIN, SUBQ
EXCISION DERMOID CYST, NOSE; COMPLEX, UNDER BONE/C
EXCISION TURBINATE, PARTIAL/COMPLETE, ANY METHOD
SUBMUCOUS RESECTION TURBINATE, PARTIAL/COMPLETE, A
Screen mammo doc rev
RHINECTOMY; PARTIAL
CERV CANCER SCREENING RESULTS DOCD AND RVWD
RHINECTOMY; TOTAL
PT SCRND UNHLTHY OH USE BY SYSTMTC SCRNG METHD
Colorectal ca screen doc rev
PRE-PRXD RSK ET AL DOCD
LVEF ASSESSMENT PLANNED POST DISCHARGE
INJECTION INTO TURBINATE(S), THERAPEUTIC
LEFT VENTRICULAR FUNCTION ASSESSMENT DOCUMENTED
DISPLACEMENT THERAPY (PROETZ TYPE)
Lvef mod/sever deprs syst
INSERTION, NASAL SEPTAL PROSTHESIS (BUTTON)
Lvef =40% systolic
Spirom doc rev
Spirom fev/fvc<70% w copd
Spirom fev/fvc=70%/ w/o copd
O2 saturation doc rev
REMOVAL FB, INTRANASAL; OFFICE TYPE PROC
REMOVAL FB, INTRANASAL; REQUIRING GENERAL ANESTHES
REMOVAL FB, INTRANASAL; LATERAL RHINOTOMY
O2 saturation =88% /pa0 =55
O2 saturation> 88% /pao>55
PULMONARY FXN TEST DONE WITHIN 12 MON B4 SURGERY
RHINOPLASTY, PRIMARY; LATERAL / ALAR CARTILAGES AN
Fev<40% predicted value
RHINOPLASTY, PRIMARY; COMPLETE, EXT PARTS W/BONY P
RHINOPLASTY, PRIMARY; W/MAJOR SEPTAL REPAIR
Fev= 40% predicted value
RHINOPLASTY, SECONDARY; MINOR REVISION (SMALL AMOU
RHINOPLASTY, SECONDARY; INTERMEDIATE REVISION (BON
HG a1c level < 7.0%
RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP
HG a1c level 7.0-9.0%
RHINOPLASTY, NASAL DEFORMITY SECONDARY TO CONG CLE
RHINOPLASTY, NASAL DEFORM SEC TO CONG CLEFT LIP/PA
REPAIR, NASAL VESTIBULAR STENOSIS (SPREADER GRAFTI
Hemoglobin a1c level > 9.0%
MOST RECENT LDL-C < 100 MG/DL
MOST RECENT LDL-C 100-129 MG/DL
MOST RECENT LDL-C >= 130 MG/DL
SEPTOPLASTY/SUBMUCOUS RESECTION W/WO CARTILAGE SCO
REPAIR CHOANAL ATRESIA; INTRANASAL
REPAIR CHOANAL ATRESIA; TRANSPALATINE
LVEF LESS THAN OR EQUAL TO 35%
LYSIS INTRANASAL SYNECHIA
LVEF GREATER THAN 35%
REPAIR FISTULA; OROMAXILLARY (COMBINE W/31030 IF A
REPAIR FISTULA; ORONASAL
Pos microalbuminuria rev
Neg microalbuminuria rev
SEPTAL/OTHER INTRANASAL DERMATOPLASTY (DOES NOT IN
Pos macroalbuminuria rev
REPAIR NASAL SEPTAL PERFORATIONS
Nephropathy doc tx
Low risk for retinopathy
DOCUMENTED LENGTH CORNEAL POWER & LENS POWER
MOST RECENT SYSTOLIC BLOOD PRESSURE <130 MM HG
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2010
1/1/2004
1/1/2009
1/1/2007
1/1/2009
1/1/2012
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2010
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2007
1/1/2010
1/1/2007
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
Y
N
Y
Y
N
Y
N
Y
Y
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
3075F
3077F
3078F
3079F
30801
30802
3080F
3082F
3083F
3084F
3085F
3088F
3089F
30901
30903
30905
30906
3090F
30915
3091F
30920
3092F
30930
3093F
3095F
3096F
30999
31000
31002
3100F
31020
31030
31032
31040
31050
31051
31070
31075
31080
31081
31084
31085
31086
31087
31090
3110F
3111F
3112F
3115F
3117F
3118F
3119F
31200
31201
31205
3120F
31225
31230
31231
31233
31235
31237
31238
31239
31240
31254
31255
31256
31267
3126F
31276
31287
31288
31290
31291
31292
31293
31294
31295
31296
31297
31299
31300
31320
31360
31365
31367
31368
31370
31375
31380
MOST RECENT SYSTOLIC BLOOD PRESS 130-139MM HG
MOST RECENT SYSTOLIC BLOOD PRESSURE >= 140 MM HG
MOST RECENT DIASTOLIC BLOOD PRESSURE < 80 MM HG
MOST RECENT DIASTOLIC BLOOD PRESSURE 80-89 MM HG
ABLTJ SOF TISS INF TURBS UNI/BI SUPFC
ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL
MOST RECENT DIASTOLIC BLOOD PRESSURE >= 90 MM HG
Kt/V <1.2
Kt/V >= 1.2 and <1.7
Kt/V >= 1.7
SUICIDE RISK ASSESSED
MDD, mild
MDD, moderate
CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITE
CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTEN
CONTROL NASAL HEMORRHAGE, POSTERIOR, W/POST NASAL
CONTROL NASAL HEMORRHAGE, POSTERIOR, W/POST NASAL
MDD, severe; w/o psych
LIGATION ARTERIES; ETHMOIDAL
MDD, severe; w/psych
LIGATION ARTERIES; INT MAXILLARY ARTERY, TRANSANTR
MDD, in remission
FX NASAL TURBINATE(S), THERAPEUTIC
Doc new diag 1st/addl. MDD
CENTRAL DXA RESULTS DOCUMENTED
CENTRAL DXA ORDERED
UNLISTED PROC, NOSE
LAVAGE, CANNULATION; MAXILLARY SINUS (ANTRUM PUNCT
LAVAGE, CANNULATION; SPHENOID SINUS
Carotid imaging study report (includes direct or indirect reference to measurements of distal in
SINUSOTOMY, MAXILLARY (ANTROTOMY); INTRANASAL
SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWE
SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWE
PTERYGOMAXILLARY FOSSA SURGERY, ANY APPROACH
SINUSOTOMY, SPHENOID, W/WO BX;
SINUSOTOMY, SPHENOID, W/WO BX; W/MUCOSAL STRIPPING
SINUSOTOMY FRONTAL; EXT, SIMPLE (TREPHINE OPERATIO
SINUSOTOMY FRONTAL; TRANSORBITAL, UNILAT (FOR MUCO
SINUSOTOMY FRONTAL; OBLITERATIVE W/O OSTEOPLASTIC
SINUSOTOMY FRONTAL; OBLITERATIVE, W/O OSTEOPLASTIC
SINUSOTOMY FRONTAL; OBLITERATIVE, W/OSTEOPLASTIC F
SINUSOTOMY FRONTAL; OBLITERATIVE, W/OSTEOPLASTIC F
SINUSOTOMY FRONTAL; NONOBLITERATIVE, W/OSTEOPLASTI
SINUSOTOMY FRONTAL; NONOBLITERATIVE, W/OSTEOPLASTI
SINUSOTOMY, UNILAT, OVER 3 PARANASAL SINUSES
DOC CT MRI RPRT OF BLDNG LESION ACUTE INFARCTION
CT OR MRI BRAIN DONE W/IN 24 HRS HOSP ARRIVAL
CT/MRI BRAIN DONE > 24 HRS AFTER HOSP ARRIVAL
QUANT RESULTS EVAL CURR LEVEL ACTIVITY CLIN SYMP
HF DISEASE SPECIFIC ASSESSMENT TOOL COMPLETED
NEW YORK HEART ASSOCIATION (NYHA) CLASS DOCD
NO EVAL LEVEL OF ACTIVITY OR CLINICAL SYMPTOMS
ETHMOIDECTOMY; INTRANASAL, ANTERIOR
ETHMOIDECTOMY; INTRANASAL, TOTAL
ETHMOIDECTOMY; EXTRANASAL, TOTAL
12-LEAD ECG PERFORMED (EM)
MAXILLECTOMY; W/O ORBITAL EXENTERATION
MAXILLECTOMY; W/ORBITAL EXENTERATION (EN BLOC)
NASAL ENDOSCOPY, DX, UNILAT/BILAT (SEP PROC)
NASAL/SINUS ENDOSCOPY, DX W/MAXILLARY SINUSOSCOPY
NASAL/SINUS ENDOSCOPY, DX W/SPHENOID SINUSOSCOPY
NASAL/SINUS ENDOSCOPY, SURGICAL; W/BX, POLYPECTOMY
NASAL/SINUS ENDOSCOPY, SURGICAL; W/CONTROL, NASAL
NASAL/SINUS ENDOSCOPY, SURGICAL; W/DACRYOCYSTORHIN
NASAL/SINUS ENDOSCOPY, SURGICAL; W/CONCHA BULLOSA
NASAL/SINUS ENDOSCOPY, SURGICAL; W/ETHMOIDECTOMY,
NASAL/SINUS ENDOSCOPY, SURGICAL; W/ETHMOIDECTOMY,
NASAL/SINUS ENDOSCOPY, SURGICAL, W/MAXILLARY ANTRO
NASAL/SINUS ENDOSCOPY, SURGICAL, W/MAXILLARY ANTRO
ESOPH BX RPRT W/DYSPLAS INFO AND APPROP GRADING
NASAL/SINUS ENDOSCOPY, SURGICAL W/FRONTAL SINUS EX
NASAL/SINUS ENDOSCOPY, SURGICAL, W/SPHENOIDOTOMY;
NASAL/SINUS ENDOSCOPY, SURGICAL, W/SPHENOIDOTOMY;
NASAL/SINUS ENDOSCOPY, SURGICAL, W/REPAIR, CEREBRO
NASAL/SINUS ENDOSCOPY, SURGICAL, W/REPAIR, CEREBRO
NASAL/SINUS ENDOSCOPY, SURGICAL; W/MEDIAL/INFERIOR
NASAL/SINUS ENDOSCOPY, SURGICAL; W/MEDIAL AND INFE
NASAL/SINUS ENDOSCOPY, SURGICAL; W/OPTIC NERVE DEC
NSL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS
NSL/SINUS NDSC SURG W/DILAT FRONTAL SINUS
NSL/SINUS NDSC SURG W/DILAT SPHENOID SINUS
UNLISTED PROC, ACCESSORY SINUSES
LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); W/REMOVAL
LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); DX
LARYNGECTOMY; TOTAL, W/O RADICAL NECK DISSECTION
LARYNGECTOMY; TOTAL, W/RADICAL NECK DISSECTION
LARYNGECTOMY; SUBTOTAL SUPRAGLOTTIC, W/O RADICAL N
LARYNGECTOMY; SUBTOTAL SUPRAGLOTTIC, W/RADICAL NEC
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); HORIZONTA
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); LATEROVER
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); ANTEROVER
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2010
1/1/2010
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2010
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
31382
31390
31395
31400
31420
31500
31502
31505
31510
31511
31512
31513
31515
31520
31525
31526
31527
31528
31529
31530
31531
31535
31536
31540
31541
31545
31546
31560
31561
31570
31571
31575
31576
31577
31578
31579
31580
31582
31584
31587
31588
31590
31595
31599
31600
31601
31603
31605
31610
31611
31612
31613
31614
31615
31620
31622
31623
31624
31625
31626
31627
31628
31629
31630
31631
31632
31633
31634
31635
31636
31637
31638
31640
31641
31643
31645
31646
31647
31648
31649
31651
31652
31653
31654
31660
31661
31717
31720
31725
31730
31750
PARTIAL LARYNGECTOMY (HEMILARYNGECTOMY); ANTERO-LA
PHARYNGOLARYNGECTOMY, W/RADICAL NECK DISSECTION; W
PHARYNGOLARYNGECTOMY, W/RADICAL NECK DISSECTION; W
ARYTENOIDECTOMY/ARYTENOIDOPEXY, EXT APPROACH
EPIGLOTTIDECTOMY
INTUBATION, ENDOTRACHEAL, EMERGENCY PROC
TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT, FI
LARYNGOSCOPY, INDIRECT; DIAGNOSTIC (SEP PROC)
LARYNGOSCOPY, INDIRECT; W/BX
LARYNGOSCOPY, INDIRECT; W/REMOVAL, FB
LARYNGOSCOPY, INDIRECT; W/REMOVAL, LESION
LARYNGOSCOPY, INDIRECT; W/VOCAL CORD INJECTION
LARYNGOSCOPY DIRECT, W/WO TRACHEOSCOPY; ASPIRATION
LARYNGOSCOPY DIRECT, W/WO TRACHEOSCOPY; DX, NEWBOR
LARYNGOSCOPY DIRECT, W/WO TRACHEOSCOPY; DX, EXCEPT
LARYNGOSCOPY DIRECT, W/WO TRACHEOSCOPY; DX, W/OPER
LARYNGOSCOPY DIRECT, W/WO TRACHEOSCOPY; W/INSERTIO
LARYNGOSCOPY DIRECT, W/WO TRACHEOSCOPY; W/DILATATI
LARYNGOSCOPY DIRECT, W/WO TRACHEOSCOPY; W/DILATATI
LARYNGOSCOPY, DIRECT, OPERATIVE, W/FB REMOVAL;
LARYNGOSCOPY, DIRECT, OPERATIVE, W/FB REMOVAL; W/O
LARYNGOSCOPY, DIRECT, OPERATIVE, W/BX;
LARYNGOSCOPY, DIRECT, OPERATIVE, W/BX; W/OPERATING
LARYNGOSCOPY, DIRECT, OPERATIVE, W/EXCISION, TUMOR
LARYNGOSCOPY, DIRECT, OPERATIVE, W/EXCISION, TUMOR
OPERATIVE LARYNGOSCOPY
OPERATIVE LARYNGOSCOPY
LARYNGOSCOPY, DIRECT, OPERATIVE, W/ARYTENOIDECTOMY
LARYNGOSCOPY, DIRECT, OPERATIVE, W/ARYTENOIDECTOMY
LARYNGOSCOPY, DIRECT, W/INJECTION INTO VOCAL CORD(
LARYNGOSCOPY, DIRECT, W/INJECTION INTO VOCAL CORD,
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DX
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; W/BX
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; W/REMOVAL, FB
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; W/REMOVAL, LESI
LARYNGOSCOPY, FLEXIBLE/RIGID FIBEROPTIC, W/STROBOS
LARYNGOPLASTY; LARYNGEAL WEB, TWO STAGE, W/KEEL IN
LARYNGOPLASTY; LARYNGEAL STENOSIS, W/GRAFT/CORE MO
LARYNGOPLASTY; W/OPEN REDUCTION, FX
LARYNGOPLASTY, CRICOID SPLIT
LARYNGOPLASTY, NOS
LARYNGEAL REINNERVATION, NEUROMUSCULAR PEDICLE
SECTION RECURRENT LARYNGEAL NERVE, THERAPEUTIC (SE
UNLISTED PROC, LARYNX
TRACHEOSTOMY, PLANNED (SEP PROC);
TRACHEOSTOMY, PLANNED (SEP PROC); UNDER AGE 2
TRACHEOSTOMY, EMERGENCY PROC; TRANSTRACHEAL
TRACHEOSTOMY, EMERGENCY PROC; CRICOTHYROID MEMBRAN
TRACHEOSTOMY, FENESTRATION PROC W/SKIN FLAPS
CONSTRUCTION, TRACHEOESOPHAGEAL FISTULA, W/SUBSEQU
TRACHEAL PUNCTURE, PERCUTANEOUS W/TRANSTRACHEAL AS
TRACHEOSTOMA REVISION; SIMPLE, W/O FLAP ROTATION
TRACHEOSTOMA REVISION; COMPLEX, W/FLAP ROTATION
TRACHEOBRONCHOSCOPY THROUGH ESTABLISHED TRACHEOSTO
ENDOBRACHIAL ULTRASOUND DURING BRONCHOSCOPIC DIAGN
BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX
BRONCHOSCOPY, RIGID/FLEX, W/WO FLUORO GUID; W/BRUS
BRONCHOSCOPY, RIGID/FLEX, W/WO FLUORO GUID; W/BRON
BRONCHOSCOPY, RIGID/FLEX, W/WO FLUORO GUID; W/BRON
BRNCHSC W/PLMT FIDUCIAL MARKERS 1/MLT
BRNCHSC W/CPTR-ASST IMAGE-GUIDED NAVIGATION
BRONCHOSCOPY, RIGID/FLEX, W/WO FLUORO GUID; W/TRAN
BRONCHOSCOPY, RIGID/FLEX, W/WO FLUORO GUID; W/TRAN
BRONCHOSCOPY, RIGID/FLEX, W/WO FLUORO GUID; W/TRAC
BRONCHOSCOPY, RIGID/FLEX, W/WO FLUORO GUID; W/TRAC
BRNCHSC W/TRANSBRNCL LUNG BX EA LOBE
BRNCHSC W/TRANSBRNCL NDL ASPIR BX EA LOBE
BRONCHOSCOPY BALLOON OCCLUSION
BRONCHOSCOPY, RIGID/FLEX, W/WO FLUORO GUID; W/REMO
BRONCHOSCOPY, WITH PLACEMENT OF BRONCHIAL STENTS
BRONCHOSCOPY, EACH ADDITIONAL MAJOR BRONCHUS STENT
BRONCHOSCOPY, WITH REVISION OF TRACHEAL OR BRONCHI
BRONCHOSCOPY, RIGID/FLEX, W/WO FLUORO GUID; W/EXCI
BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC
BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL
BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST
BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ
BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE
BRNCHSC REMOVAL BRONCHIAL VALVE INITIAL
BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE
BRNCHSC REMOVAL BRONCHIAL VALVE EA ADDL
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORM
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORM
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORM
BRONCHOSCOPIC THERMOPLASTY ONE LOBE
BRONCHOSCOPIC THERMOPLASTY 2/> LOBES
CATHETERIZATION W/BRONCHIAL BRUSH BX
CATHETER ASPIRATION (SEP PROC); NASOTRACHEAL
CATHETER ASPIRATION (SEP PROC); TRACHEOBRONCHIAL W
TRANSTRACHEAL INTRODUCTION, NEEDLE WIRE DILATOR/ST
TRACHEOPLASTY; CERVICAL
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
7/1/2005
7/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2016
1/1/2016
1/1/2016
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
31755
31760
31766
31770
31775
31780
31781
31785
31786
31800
31805
31820
31825
31830
31899
32035
32036
32096
32097
32098
32100
32110
32120
32124
32140
32141
32150
32151
32160
32200
32215
32220
32225
32310
32320
32400
32405
32440
32442
32445
32480
32482
32484
32486
32488
32491
32501
32503
32504
32505
32506
32507
32540
32550
32551
32552
32553
32554
32555
32556
32557
32560
32561
32562
32601
32604
32606
32607
32608
32609
3260F
32650
32651
32652
32653
32654
32655
32656
32658
32659
3265F
32661
32662
32663
32664
32665
32666
32667
32668
32669
3266F
TRACHEOPLASTY; TRACHEOPHARYNGEAL FISTULIZATION, EA
TRACHEOPLASTY; INTRATHORACIC
CARINAL RECONSTRUCTION
BRONCHOPLASTY; GRAFT REPAIR
BRONCHOPLASTY; EXCISION STENOSIS AND ANASTOMOSIS
EXCISION TRACHEAL STENOSIS AND ANASTOMOSIS; CERVIC
EXCISION TRACHEAL STENOSIS AND ANASTOMOSIS; CERVIC
EXCISION, TRACHEAL TUMOR/CARCINOMA; CERVICAL
EXCISION, TRACHEAL TUMOR/CARCINOMA; THORACIC
SUTURE, TRACHEAL WOUND/INJURY; CERVICAL
SUTURE, TRACHEAL WOUND/INJURY; INTRATHORACIC
SURGICAL CLOSURE TRACHEOSTOMY/FISTULA; W/O PLASTIC
SURGICAL CLOSURE TRACHEOSTOMY/FISTULA; W/PLASTIC R
REVISION, TRACHEOSTOMY SCAR
UNLISTED PROC, TRACHEA, BRONCHI
THORACOSTOMY; W/RIB RESECTION, EMPYEMA
THORACOSTOMY; W/OPEN FLAP DRAINAGE, EMPYEMA
THORACTOMY W/DX BX LUNG INFILTRATE UNILATERAL
THORACTOMY W/DX BX LUNG NODULE/MASS UNILATERAL
THORACOTOMY W/BIOPSY OF PLEURA
THORACOTOMY, MAJOR; W/EXPLORATION AND BX
THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR
THORACOTOMY, MAJOR; POSTOPERATIVE COMPLICATIONS
THORACOTOMY, MAJOR; W/OPEN INTRAPLEURAL PNEUMONOLY
THORACOTOMY, MAJOR; W/CYST(S) REMOVAL, W/WO A PLEU
THORACOTOMY W/RESECTION BULLAE
THORCOM W/RMVL INTRAPLEURAL FB/FIBRIN DEP
THORCOM W/RMVL IPUL FB
THORACOTOMY, MAJOR; W/CARDIAC MASSAGE
PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST
PLEURAL SCARIFICATION, REPEAT PNEUMOTHORAX
DECORTICATION, PULMONARY (SEP PROC); TOTAL
DECORTICATION, PULMONARY (SEP PROC); PARTIAL
PLEURECTOMY, PARIETAL (SEP PROC)
DECORTICATION AND PARIETAL PLEURECTOMY
BX, PLEURA; PERCUTANEOUS NEEDLE
BX, LUNG/MEDIASTINUM, PERCUTANEOUS NEEDLE
REMOVAL OF LUNG PNEUMONECTOMY
REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA
REMOVAL LUNG PNEUMONECTOMY EXTRAPLEURAL
RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT
RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC
RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY
RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY
RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC
RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG
RESECTION/REPAIR, PORTION, BRONCHUS, DURING LOBECT
RESECTION OF APICAL LUNG TUMOR; WHEN PERFORMED; WI
RESECTION OF APICAL LUNG TUMOR; WHEN PERFORMED; WI
THORACOTOMY W/THERAPEUTIC WEDGE RESEXN INITIAL
THORACOTOMY W/THERAP WEDGE RESEXN ADDL IPSILATRL
THORACOTOMY W/DX WEDGE RESEXN &ANTOM LUNG RESEXN
EXTRAPLEURAL ENUCLEATION, EMPYEMA (EMPYEMECTOMY)
INSERTION INDWELLING TUNNELED PLEURAL CATH W/CUFF
TUBE THORACOSTOMY INCLUDES WATER SEAL (SEP PROC)
RMVL NDWELLG TUN PLEURAL CATH W/CUFF
PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT
THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING
PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS
INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY
INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY
THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX
THORACOSCOPY, DX (SEP PROC); PERICARDIAL SAC, W/BX
THORACOSCOPY, DX (SEP PROC); MEDIASTINAL SPACE, W/
THORACOSCOPY W/DX BX OF LUNG INFILTRATE UNILATRL
THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL
THORACOSCOPY WITH BIOPSYIES OF PLEURA
PT CATEGORY PN CATEGORY AND HISTORIC GRADE DOCUMEN
THORACOSCOPY, SURGICAL; W/PLEURODESIS (MECHANICAL/
THORACOSCOPY, SURGICAL; W/PARTIAL PULMONARY DECORT
THORACOSCOPY, SURGICAL; W/TOTAL PULMONARY DECORTIC
THORACOSCOPY, SURGICAL; W/REMOVAL, INTRAPLEURAL FB
THORACOSCOPY, SURGICAL; W/CONTROL, TRAUMATIC HEMOR
THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX
THORACOSCOPY, SURGICAL; W/PARIETAL PLEURECTOMY
THORACOSCOPY, SURGICAL; W/REMOVAL, CLOT/FB, PERICA
THORACOSCOPY, SURGICAL; W/CREATION, PERICARDIAL WI
RNA TESTING FOR HEP C VIREMIA ORDERED/DOCD
THORACOSCOPY, SURGICAL; W/EXCISION, PERICARDIAL CY
THORACOSCOPY, SURGICAL; W/EXCISION, MEDIASTINAL CY
THORACOSCOPY, SURGICAL; W/LOBECTOMY, TOTAL/SEGMENT
THORACOSCOPY, SURGICAL; W/THORACIC SYMPATHECTOMY
THORACOSCOPY, SURGICAL; W/ESOPHAGOMYOTOMY
THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT
THORACOSCOPY W/THERA WEDGE RESEXN ADDL IPSILATRL
THORACOSCOPY W/DX WEDGE RESEXN ANATO LUNG RESEXN
THORACOSCOPY W/SEGMENTECTOMY
HEP C GENO TSTNG DOCD B/4 ANTIVRL TXMNT HEP C
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2008
1/1/2008
1/1/2010
1/1/2010
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2010
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2008
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
32670
32671
32672
32673
32674
3267F
3268F
3269F
32701
3270F
3271F
3272F
3273F
3274F
3278F
3279F
32800
3280F
32810
32815
3281F
32820
3284F
32850
32851
32852
32853
32854
32855
32856
3285F
3288F
32900
32905
32906
3290F
3291F
3292F
3293F
32940
3294F
32960
32997
32998
32999
3300F
33010
33011
33015
3301F
33020
33025
33030
33031
33050
33120
33130
3313F
33140
33141
3314F
3315F
3316F
3317F
3318F
3319F
33202
33203
33206
33207
33208
3320F
33210
33211
33212
33213
33214
33215
33216
33217
33218
3321F
33220
33221
33222
33223
33224
33225
33226
33227
33228
THORACOSCOPY W/BILOBECTOMY
THORACOSCOPY W/PNEUMONECTOMY
THORACOSCOPY W/RESEXN-PLICAJ EMPHYSEMA LUNG UNIL
THORACOSCOPY RESEXN THYMUS UNI/BILATERAL
THORCOSCPY W/MEDIASTINL &REGIONL LYMPHADENECTOMY
PATH RPRT INCLUDES PT + PN CAT GLEASON + MARGIN
PSA 1 TM T STG & GLEASON SCORE DOCD BE/R TXMNT
BONE SCAN DONE B/4 TXMNT/AFTR DIAG OF PRST CNCR
THORAX STEREOTACTIC RADIATION TARGET W/TX COURSE
BONE SCAN NOT DONE B/4 TXMNT/AFTR DIAG PRST CNCR
LOW RISK OF RECURRENCE PROSTATE CANCER
INTERMED RISK OF RECURRENCE PROSTATE CANCER
HIGH RISK OF RECURRENCE PROSTATE CANCER
PROST CANCER RSK RECUR NOT KNWN/NOT LOW-HIGH
SERUM LEVELS: CA P INTACT PTH & LIPID PROF
HB LEVEL GREATER >= TO 13 G/DL
REPAIR LUNG HERNIA THROUGH CHEST WALL
HB LEVEL 11 G/DL TO 12.9 G/DL
CLOSURE, CHEST WALL FOLLOWING OPEN FLAP DRAINAGE,
OPEN CLOSURE, MAJOR BRONCHIAL FISTULA
HB LEVEL< 11 G/DL
MAJOR RECONSTRUCTION, CHEST WALL (POSTTRAUMATIC)
IOP REDUCED >= 15% PRE-INTERVENTION LEVEL
DONOR PNEUMONECTOMY(IES) W/PREPARATION AND MAINTEN
LUNG TRANSPLANT, SINGLE; W/O CARDIOPULMONARY BYPAS
LUNG TRANSPLANT, SINGLE; W/CARDIOPULMONARY BYPASS
LUNG TRANSPLANT, DOUBLE (BILAT SEQUENTIAL/EN BLOC)
LUNG TRANSPLANT, DOUBLE (BILAT SEQUENTIAL/EN BLOC)
PREP OF CADAVER DONOR LUNG ALLOGRAFT PRIOR TO TRAN
PREP OF CADAVER DONOR LUNG ALLOGRAFT PRIOR TO TRAN
IOP REDUCED < 15% PRE-INTERVENTION LEVEL
FALLS RISK ASSESSMENT DOCUMENTED
RESECTION, RIBS, EXTRAPLEURAL, ALL STAGES
THORACOPLASTY, SCHEDE TYPE/EXTRAPLEURAL (ALL STAGE
THORACOPLASTY, SCHEDE TYPE/EXTRAPLEURAL (ALL STAGE
PATIENT IS D (RH) NEGATIVE AND UNSENSITIZED
PATIENT IS D (RH) POSITIVE OR SENSITIZED
HIV TSTNG ASK/DOCD/RVWD AT 1ST/2ND PRENATAL VST
ABO AND RH BLOOD TYPING DOCUMENTED AS PERFORMED
PNEUMONOLYSIS, EXTRAPERIOSTEAL, W/FILLING/PACKING
GBS SCRNING DOCD DONE DURING WK 35-37 GESTATION
PNEUMOTHORAX, THERAPEUTIC, INTRAPLEURAL INJECTION,
TOTAL LUNG LAVAGE (UNILAT)
Perq rf ablate tx, pul tumor
UNLISTED PROC, LUNGS AND PLEURA
AJCC STAGE DOCD & RVWD B/4 STARTING THERAPY
PERICARDIOCENTESIS; INITIAL
PERICARDIOCENTESIS; SUBSEQUENT
TUBE PERICARDIOSTOMY
CNCR STG DOCD AS METAST & RVWD B/4 THXPY
PERICARDIOTOMY, REMOVAL, CLOT/FB (PRIMARY PROC)
CREATION, PERICARDIAL WINDOW/PARTIAL RESECTION, DR
PERICARDIECTOMY, SUBTOTAL/COMPLETE; W/O CARDIOPULM
PERICARDIECTOMY, SUBTOTAL/COMPLETE; W/CARDIOPULMON
RESECTION PERICARDIAL CYST/TUMOR
EXCISION, INTRACARDIAC TUMOR, RESECTION W/CARDIOPU
RESECTION, EXT CARDIAC TUMOR
AJCC CANCER STAGE IVB DOCUMENTED
TRANSMYOCARDIAL LASER REVASCULARIZATION, BY THORAC
TRANSMYOCARDIAL LASER REVASCULARIZATION, BY THORAC
AJCC CANCER STAGE IVC DOCUMENTED
ER POSITIVE OR PR POSITIVE BREAST CANCER
ER OR PR BREAST CANCER
PATH RPT MALIG CANCER DOCD
PATH RPT MALIG CANCER DOCD
X-RAY/CT/ULTRSND ET AL ORDD
Insert epicard eltrd, open
Insert epicard eltrd, endo
INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL
INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR
INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT
NO XRAY/CT/ ET AL ORDD
INSERTION/REPLACEMENT, TEMPORARY TRANSVENOUS SINGL
INSERTION/REPLACEMENT, TEMPORARY TRANSVENOUS DUAL
INS PM PLS GEN W/EXIST SINGLE LEAD
INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS
UPGRADE, IMPLANTED PACEMAKER, CONVERSION, SINGLE T
REPOSITIONING, PREVIOUSLY IMPLANTED TRANSVENOUS EL
INSERTION, TRANSVENOUS ELECTRODE; SINGLE CHAMBER P
INSERTION/REPOSITIONING, TRANSVENOUS ELECTRODE; DU
RPR 1 ELTRD PRM PM/PACING CVDFB
AJCC CANCER STAGE 0 OR 1A MELANOMA DOCD
RPR 2 ELTRDS PRM PM/PACING CVDFB
INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS
RELOCATION OF SKIN POCKET FOR PACEMAKER
RELOCATE SKIN POCKET CARDIOVERTER-DEFIBRILLATOR
INSJ ELTRD CAR VEN SYS ATTCH PM/CVDFB PLS GEN
INSJ ELTRD CAR VEN SYS TM INSJ CVDFB/PM PLS GEN
RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD
REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD
REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
7/1/2011
1/1/2008
1/1/2008
1/1/2013
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2010
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
33229
3322F
33230
33231
33233
33234
33235
33236
33237
33238
3323F
33240
33241
33243
33244
33249
3324F
33250
33251
33254
33255
33256
33257
33258
33259
3325F
33261
33262
33263
33264
33265
33266
33270
33271
33272
33273
33282
33284
3328F
33300
33305
3330F
33310
33315
3331F
33320
33321
33322
33330
33335
33361
33362
33363
33364
33365
33366
33367
33368
33369
33400
33401
33403
33404
33405
33406
3340F
33410
33411
33412
33413
33414
33415
33416
33417
33418
33419
3341F
33420
33422
33425
33426
33427
3342F
33430
3343F
3344F
3345F
33460
33463
33464
33465
REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD
MELANOMA GREATER THAN AJCC STAGE 0 OR IA
INS PACNG CVDFB PLS GEN ONLY W/EXIST DUAL LEADS
INS PACNG CVDFB PLS GEN ONLY W/EXIST MULTI LEADS
REMOVAL, PERMANENT PACEMAKER PULSE GENERATOR
REMOVAL, TRANSVENOUS PACEMAKER ELECTRODE(S); SINGL
REMOVAL, TRANSVENOUS PACEMAKER ELECTRODE(S); DUAL
REMOVAL, PERMANENT EPICARDIAL PACEMAKER/ELECTRODES
REMOVAL, PERMANENT EPICARDIAL PACEMAKER AND ELECTR
REMOVAL, PERMANENT TRANSVENOUS ELECTRODE(S), THORA
CLIN TUMOR NODE METASTASES STAGING DOCD B4 SURG
INSJ 1/2 CHMBR PACING CARDIOVERTERDEFIB PLS GEN
REMVL PAC CVDFB PLS GEN ONLY
REMOVAL, SINGLE/DUAL CHAMBER PACING CARDIOVERTER-D
REMOVAL, SINGLE/DUAL CHAMBER PACING CARDIOVERTER-D
INS/REP PAC PERM CVDFB TRNSVEN LEADS 1/2 CHAMBER
MRI CT SCAN ORDERED RVWD OR REQUESTED
OPERATIVE ABLATION, SUPRAVENTRICULAR ARRHYTHMOGENI
OPERATIVE ABLATION, SUPRAVENTRICULAR ARRHYTHMOGENI
Ablate atria, lmtd
Ablate atria w/o bypass, ext
Ablate atria w/bypass, exten
ATRIA ABLATE & RCNSTJ W OTHER PROCEDURE LIMITED
ATRIA ABLTJ & RCNSTJ W OTHER PX EXTENSIVE W/O BYP
ATRIA ABLATE & RCNSTJ W OTHER PX EXTENSIVE W BYP
PREOP ASSES 4 CATARACT SURG
OPERATIVE ABLATION, VENTRICULAR ARRHYTHMOGENIC FOC
REM PAC CVDFB PLSE GEN &REPL PLSE GEN SNGL LEAD
REM PAC CVDFB PLSE GEN &REPL PLSE GEN DUAL LEAD
REM PAC CVDFB PLS GEN &REPL PLSE GEN MULTI LEAD
Ablate atria w/bypass, endo
Ablate atria w/o bypass endo
INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD
INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB
IMPLANTATION OF PATIENT-ACTIVATED CARDIAC EVENT RE
REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDI
PERFORMANCE STATUS DOCD RVWD IN 2 WKS B4 SURG
REPAIR, CARDIAC WOUND; W/O BYPASS
REPAIR, CARDIAC WOUND; W/CARDIOPULMONARY BYPASS
IMAGING STUDY ORDERED (BKP)
CARDIOTOMY, EXPLORATORY W/REMOVAL FB/THROMBUS; W/O
CARDIOTOMY, EXPLORATORY W/REMOVAL, FB; W/CARDIOPUL
BK IMAGING TST NOT ORDERED
SUTURE REPAIR, AORTA/GREAT VESSELS; W/O SHUNT/CARD
SUTURE REPAIR, AORTA/GREAT VESSELS; W/SHUNT BYPASS
SUTURE REPAIR, AORTA/GREAT VESSELS; W/CARDIOPULMON
INSERTION, GRAFT, AORTA/GREAT VESSELS; W/O SHUNT/C
INSERTION, GRAFT, AORTA/GREAT VESSELS; W/CARDIOPUL
REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH
REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH
REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH
REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH
REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH
TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE
REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH
REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH
REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH
VALVULOPLASTY, AORTIC VALVE; OPEN, W/CARDIOPULMONA
VALVULOPLASTY, AORTIC VALVE; OPEN, W/INFLOW OCCLUS
VALVULOPLASTY, AORTIC VALVE; USING TRANSVENTRICULA
CONSTRUCTION, APICAL-AORTIC CONDUIT
REPLACEMENT AORTIC VALVE W/CARDIOPULM BYPASS; PROS
REPLACEMENT AORTIC VALVE W/CARDIOPULM BYPASS; W/AL
BRST IMAG-RPT/DATACAT 0 DOCD
REPLACEMENT AORTIC VALVE W/CARDIOPULM BYPASS; W/ST
RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS
REPLACEMENT, AORTIC VALVE; W/TRANSVENTRICULAR AORT
REPLACEMENT, AORTIC VALVE; TRANSLOCATION, AUTOLOGO
REPAIR, LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION
RESECTION/INCISION, SUBVALVULAR TISSUE, DISCRETE S
VENTRICULOMYOTOMY/MYECTOMY, IDIOPATHIC HYPERTROPHI
AORTOPLASTY (GUSSET), SUPRAVALVULAR STENOSIS
TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS
TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS
BRST IMAG-RPT/DATACAT 1 DOCD
VALVOTOMY, MITRAL VALVE; CLOSED HEART
VALVOTOMY, MITRAL VALVE; OPEN HEART, W/CARDIOPULMO
VALVULOPLASTY, MITRAL VALVE, W/CARDIOPULMONARY BYP
VALVULOPLASTY, MITRAL VALVE, W/CARDIOPULMONARY BYP
VALVULOPLASTY, MITRAL VALVE, W/CARDIOPULMONARY BYP
BRST IMAG-RPT/DATACAT 2 DOCD
REPLACEMENT, MITRAL VALVE, W/CARDIOPULMONARY BYPAS
BRST IMAG-RPT/DATACAT 3 DOCD
BRST IMAG-RPT/DATACAT 4 DOCD
BRST IMAG-RPT/DATACAT 5 DOCD
VALVECTOMY, TRICUSPID VALVE, W/CARDIOPULMONARY BYP
VALVULOPLASTY, TRICUSPID VALVE; W/O RING INSERTION
VALVULOPLASTY, TRICUSPID VALVE; W/RING INSERTION
REPLACEMENT, TRICUSPID VALVE, W/CARDIOPULMONARY BY
1/1/2012
10/1/2008
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2007
1/1/2007
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2014
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
Y
Y
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
33468
33470
33471
33474
33475
33476
33477
33478
33496
33500
33501
33502
33503
33504
33505
33506
33507
33508
33510
33511
33512
33513
33514
33516
33517
33518
33519
3351F
33521
33522
33523
3352F
33530
33533
33534
33535
33536
3353F
33542
33545
33548
3354F
33572
33600
33602
33606
33608
33610
33611
33612
33615
33617
33619
33620
33621
33622
33641
33645
33647
33660
33665
33670
33675
33676
33677
33681
33684
33688
33690
33692
33694
33697
33702
3370F
33710
33720
33722
33724
33726
3372F
33730
33732
33735
33736
33737
3374F
33750
33755
33762
33764
33766
TRICUSPID VALVE REPOSITIONING AND PLICATION, EBSTE
VALVOTOMY, PULMONARY VALVE, CLOSED HEART; TRANSVEN
VALVOTOMY, PULMONARY VALVE, CLOSED HEART; VIA PULM
VALVOTOMY, PULMONARY VALVE, OPEN HEART; W/CARDIOPU
REPLACEMENT, PULMONARY VALVE
RIGHT VENTRICULAR RESECTION, INFUNDIBULAR STENOSIS
TRANSCATHETER PULMONARY VALVE IMPLANTATION, PERCUTANEOUS APPROACH, INCLUDIN
OUTFLOW TRACT AUGMENTATION (GUSSET), W/WO COMMISSU
REPAIR, PROSTHETIC VALVE DYSFUNCTION W/CARDIOPULMO
REPAIR, CORONARY AV/ARTERIOCARDIAC CHAMBER FISTULA
REPAIR, CORONARY AV/ARTERIOCARDIAC CHAMBER FISTULA
REPAIR, ANOMALOUS CORONARY ARTERY; LIGATION
REPAIR, ANOMALOUS CORONARY ARTERY; GRAFT, W/O CARD
REPAIR, ANOMALOUS CORONARY ARTERY; GRAFT, W/CARDIO
REPAIR, ANOMALOUS CORONARY ARTERY; W/CONSTRUCTION,
REPAIR, ANOMALOUS CORONARY ARTERY; TRANSLOCATION,
REPAIR OF ANOMALOUS CORONARY ARTERY BY UNROOFING O
ENDOSCOPY W/VIDEO-ASSISTED VEIN HARVEST, CABG PROC
CORONARY ARTERY BYPASS, VEIN ONLY; SINGLE CORONARY
CORONARY ARTERY BYPASS, VEIN ONLY; 2 CORONARY VENO
CORONARY ARTERY BYPASS, VEIN ONLY; 3 CORONARY VENO
CORONARY ARTERY BYPASS, VEIN ONLY; 4 CORONARY VENO
CORONARY ARTERY BYPASS, VEIN ONLY; 5 CORONARY VENO
CORONARY ARTERY BYPASS, VEIN ONLY; OVER 6 CORONARY
CORONARY ARTERY BYPASS, VENOUS/ARTERIAL GRAFTS; 1
CORONARY ARTERY BYPASS, VENOUS/ARTERIAL GRAFTS; 2
CORONARY ARTERY BYPASS, VENOUS/ARTERIAL GRAFTS; 3
NEG DEP SYMP CAT USING STAND DEP ASSESS TOOL
CORONARY ARTERY BYPASS, VENOUS/ARTERIAL GRAFTS; 4
CORONARY ARTERY BYPASS, VENOUS/ARTERIAL GRAFTS; 5
CORONARY ARTERY BYPASS, VENOUS/ARTERIAL GRAFTS; OV
NO SIGNIF DEP SYMP CAT BY STAND DEP ASSESS TOOL
REOPERATION, CORONARY ARTERY BYPASS/VALVE PROC, MO
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); S
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); 2
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); 3
CORONARY ARTERY BYPASS, USING ARTERIAL GRAFT(S); O
MILD TO MOD DEP SYMP BY STAND DEP ASSESS TOOL
MYOCARDIAL RESECTION (VENTRICULAR ANEURYSMECTOMY)
REPAIR, POSTINFARCTION VENTRICULAR SEPTAL DEFECT,
SURG VENTRICULAR RESTORATION PROCEDURE; INCLUDES P
CLIN SIGN DEP SYMP BY STAND DEP ASSESS TOOL
CORONARY ENDARTERECTOMY, OPEN, LAD/CIRCUMFLX/RCA W
CLOSURE, ATRIOVENTRICULAR VALVE (MITRAL/TRICUSPID)
CLOSURE, SEMILUNAR VALVE (AORTIC/PULMONARY), SUTUR
ANASTOMOSIS, PULMONARY ARTERY TO AORTA
REPAIR, COMPLEX CARDIAC ANOMALY, NON-PULM ATRESIA,
REPAIR, COMPLEX CARDIAC ANOMALIES, SURG ENLARGEMEN
REPAIR, DOUBLE OUTLET RIGHT VENTRICLE W/INTRAVENTR
REPAIR, DOUBLE OUTLET RIGHT VENTRICLE W/INTRAVENT
REPAIR, COMPLEX CARDIAC ANOMALIES, CLOSURE, ATRIAS
REPAIR, COMPLEX CARDIAC ANOMALIES, MODIFIED FONTAN
REPAIR, SINGLE VENTRICLE W/AORTIC OUTFLOW OBSTRUCT
APPLICATION RIGHT & LEFT PULMONARY ARTERY BANDS
TTHRC CATHETER INSERT FOR STENT PLACEMENT
RECONSTRUCTION COMPLEX CARDIAC ANOMALY
REPAIR, ATRIAL SEPTAL DEFECT, SECUNDUM, W/CARDIOPU
DIRECT/PATCH CLOSURE, SINUS VENOSUS, W/WO ANOMALOU
REPAIR, ATRIAL SEPTAL DEFECT AND VENTRICULAR SEPTA
REPAIR, INCOMPLETE/PARTIAL ATRIOVENTRICULAR CANAL,
REPAIR, INTERMEDIATE/TRANSITIONAL ATRIOVENTRICULAR
REPAIR, COMPLETE ATRIOVENTRICULAR CANAL, W/WO PROS
Close mult vsd
Close mult vsd w/resection
Cl mult vsd w/rem pul band
CLOSURE, VENTRICULAR SEPTAL DEFECT, W/WO PATCH
CLOSURE, VENTRICULAR SEPTAL DEFECT, W/WO PATCH; W/
CLOSURE, VENTRICULAR SEPTAL DEFECT, W/WO PATCH; W/
BANDING, PULMONARY ARTERY
COMPLETE REPAIR TETRALOGY, FALLOT W/O PULMONARY AT
COMPLETE REPAIR TETRALOGY, FALLOT W/O PULMONARY AT
REPAIR TETRALOGY, FALLOT W/PULM ATRESIA W/CONSTRUC
REPAIR SINUS, VALSALVA FISTULA, W/CARDIOPULMONARY
AJCC BREAST CANCER STAGE 0 DOCD
REPAIR SINUS, VALSALVA FISTULA, W/CARDIOPULMONARY
REPAIR SINUS, VALSALVA ANEURYSM, W/CARDIOPULMONARY
CLOSURE, AORTICO-LEFT VENTRICULAR TUNNEL
Repair venous anomaly
Repair pul venous stenosis
AJCC BRST CANCER STAGE 1 T1MIC T1A OR T1B DOCD
COMPLETE REPAIR, ANOMALOUS VENOUS RETURN (SUPRACAR
REPAIR, COR TRIATRIATUM/SUPRAVALVULAR MITRAL RING,
ATRIAL SEPTECTOMY/SEPTOSTOMY; CLOSED HEART
ATRIAL SEPTECTOMY/SEPTOSTOMY; OPEN HEART, W/CARDIO
ATRIAL SEPTECTOMY/SEPTOSTOMY; OPEN HEART, W/INFLOW
AJCC BRST CANCER STAGE 1 TIC (&GT;1-2 CM) DOCD
SHUNT; SUBCLAVIAN TO PULMONARY ARTERY
SHUNT; ASCENDING AORTA TO PULMONARY ARTERY
SHUNT; DESCENDING AORTA TO PULMONARY ARTERY
SHUNT; CENTRAL, W/PROSTHETIC GRAFT
SHUNT; SUPERIOR VENA CAVA TO PULMONARY ARTERY, FLO
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
7/1/2008
1/1/2004
1/1/2004
1/1/2004
7/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
7/1/2008
1/1/2004
1/1/2004
1/1/2006
7/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
33767
33768
3376F
33770
33771
33774
33775
33776
33777
33778
33779
33780
33781
33782
33783
33786
33788
3378F
33800
33802
33803
3380F
33813
33814
33820
33822
33824
3382F
33840
33845
3384F
33851
33852
33853
33860
33863
33864
3386F
33870
33875
33877
33880
33881
33883
33884
33886
33889
3388F
33891
3390F
33910
33915
33916
33917
33920
33922
33924
33925
33926
33930
33933
33935
33940
33944
33945
33946
33947
33948
33949
3394F
33951
33952
33953
33954
33955
33956
33957
33958
33959
3395F
33962
33963
33964
33965
33966
33967
33968
33969
33970
33971
33973
SHUNT; SUPERIOR VENA CAVA TO PULMONARY ARTERY, FLO
ANASTOMOSIS, CAVOPULMONARY, SECOND SUPERIOR VENA C
AJCC BREAST CANCER STAGE II DOCD
REPAIR, TRANSPOSITION GREAT ARTERIES; W/O SURGICAL
REPAIR, TRANSPOSITION GREAT ARTERIES; W/SURGICAL E
REPAIR, TRANSPOSITION GREAT ARTERIES, ATRIAL BAFFL
REPAIR, TRANSPOSITION GREAT ARTERIES, ATRIAL BAFFL
REPAIR, TRANSPOSITION GREAT ARTERIES, ATRIAL BAFFL
REPAIR, TRANSPOSITION GREAT ARTERIES, ATRIAL BAFFL
REPAIR, TRANSPOSITION GREAT ARTERIES, AORTOPULMONA
REPAIR, TRANSPOSITION GREAT ARTERIES, AORTOPULMONA
REPAIR, TRANSPOSITION GREAT ARTERIES, AORTOPULMONA
REPAIR, TRANSPOSITION GREAT ARTERIES, AORTOPULMONA
A-ROOT TLCJ VSD PULM STNS RPR W/O C OST RIMPLTJ
A-ROOT TLCJ VSD PULM STNS RPR W/ RIMPLTJ C OSTIA
TOTAL REPAIR, TRUNCUS ARTERIOSUS
REIMPLANTATION, ANOMALOUS PULMONARY ARTERY
AJCC BREAST CANCER STAGE III DOCD
AORTIC SUSPENSION, TRACHEAL DECOMPRESSION (SEP PRO
DIVISION, ABERRANT VESSEL (VASCULAR RING);
DIVISION, ABERRANT VESSEL (VASCULAR RING); W/REANA
AJCC BREAST CANCER STAGE IV DOCD
OBLITERATION, AORTOPULMONARY SEPTAL DEFECT; W/O CA
OBLITERATION, AORTOPULMONARY SEPTAL DEFECT; W/CARD
REPAIR, PATENT DUCTUS ARTERIOSUS; LIGATION
REPAIR, PATENT DUCTUS ARTERIOSUS; DIVISION, UNDER
REPAIR, PATENT DUCTUS ARTERIOSUS; DIVISION, OVER A
AJCC COLON CANCER STAGE 0 DOCD
EXCISION, COARCTATION, AORTA W/WO PATENT DUCTUS AR
EXCISION, COARCTATION, AORTA W/WO PATENT DUCTUS AR
AJCC COLON CANCER STAGE I DOCD
EXCISION, COARCTATION, AORTA; REPAIR W/LEFT SUBCLA
REPAIR, HYPOPLASTIC AORTIC ARCH W/AUTOGENOUS/PROST
REPAIR, HYPOPLASTIC AORTIC ARCH W/AUTOGENOUS/PROST
ASCENDING AORTA GRF W/CARD BYP & VALVE SSP
AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT
ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL
AJCC COLON CANCER STAGE II DOCD
TRANSVERSE ARCH GRAFT, W/CARDIOPULMONARY BYPASS
DESCENDING THORACIC AORTA GRAFT, W/WO BYPASS
REPAIR, THORACOABDOMINAL AORTIC ANEURYSM W/GRAFT,
ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA;
ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA;
PLACEMENT OF PROXIMAL EXT PROSTHESIS FOR ENDOVASCU
PLACEMENT OF PROXIMAL EXT PROSTHESIS FOR ENDOVASCU
PLACEMENT OF DISTAL EXT PROSTHESIS
OPEN SUBCLAVIAN TO CAROTID ARTERY TRANSPOSITION; U
AJCC COLON CANCER STAGE III DOCD
BYPASS GRAFT, TRANSCERVICAL CAROTID-CAROTID; BY NE
AJCC COLON CANCER STAGE IV DOCD
PULMONARY ARTERY EMBOLECTOMY; W/CARDIOPULMONARY BY
PULMONARY ARTERY EMBOLECTOMY; W/O CARDIOPULMONARY
PULMONARY ENDARTERECTOMY, W/WO EMBOLECTOMY, W/CARD
REPAIR, PULMONARY ARTERY STENOSIS, RECONSTRUCTION
REPAIR, PULMONARY ATRESIA, W/CONSTRUCT/REPLACE CON
TRANSECTION, PULMONARY ARTERY W/CARDIOPULMONARY BY
LIGATION/TAKEDOWN, SYSTEMIC-TO-PULMONARY ARTERY SH
REPAIR OF PULMONARY ARTERY ARBORIZATION; WITHOUT C
REPAIR OF PULMONARY ARTERY ARBORIZATION; WITH CARD
DONOR CARDIECTOMY-PNEUMONECTOMY, W/PREPARATION AND
PREP OF CADAVER DONOR HEART/LUNG ALLOGRAFT
HEART-LUNG TRANSPLANT W/RECIPIENT CARDIECTOMY-PNEU
DONOR CARDIECTOMY, W/PREPARATION AND MAINTENANCE,
BACKBENCH STANDARD PREPARATION OF CADAVER DONOR HE
HEART TRANSPLANT, W/WO RECIPIENT CARDIECTOMY
ECMO/ECLS INITIATION VENO-VENOUS
ECMO/ECLS INITIATION VENO-ARTERIAL
ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS
ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL
QUANT HER2 IHC EVAL OF BRST CANCER - ASCO/CAP
ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ
ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ
ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN
ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN
ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS
ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER
ECMO/ECLS REPOS PERIPH CANNULA PERQ BIRTH-5 YRS
ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER
ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS
QUANT NON-HER2 IHC EVAL OF BRST CANCER PERFORMED
ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER
ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS
ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER
ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS
ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER
INSERTION, INTRA-AORTIC BALLOON ASSIST DEVICE, PER
REMOVAL, INTRA-AORTIC BALLOON ASSIST DEVICE, PERCU
ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS
INSERTION, INTRA-AORTIC BALLOON ASSIST DEVICE THRO
REMOVAL, INTRA-AORTIC BALLOON ASSIST DEVICE W/REPA
INSERTION, INTRA-AORTIC BALLOON ASSIST DEVICE THRO
1/1/2004
1/1/2006
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
10/1/2008
1/1/2006
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2015
1/1/2015
1/1/2015
1/1/2015
7/1/2011
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
7/1/2011
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
33974
33975
33976
33977
33978
33979
33980
33981
33982
33983
33984
33985
33986
33987
33988
33989
33990
33991
33992
33993
33999
34001
34051
34101
34111
34151
34201
34203
34401
34421
34451
34471
34490
34501
34502
3450F
34510
3451F
34520
3452F
34530
3455F
3470F
3471F
3472F
3475F
3476F
34800
34802
34803
34804
34805
34806
34808
34812
34813
34820
34825
34826
34830
34831
34832
34833
34834
34839
34841
34842
34843
34844
34845
34846
34847
34848
34900
3490F
3491F
3492F
3493F
3494F
3495F
3496F
3497F
3498F
35001
35002
35005
3500F
35011
35013
35021
35022
REMOVAL, INTRA-AORTIC BALLOON ASSIST DEVICE, ASCEN
INSERTION, VENTRICULAR ASSIST DEVICE; EXTRACORPORE
INSERTION, VENTRICULAR ASSIST DEVICE; EXTRACORPORE
REMOVAL, VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL
REMOVAL, VENTRICULAR ASSIST DEVICE; EXTRACORPOREAL
INSERTION, VENTRICULAR ASSIST DEVICE, IMPLANTABLE
REMOVAL, VENTRICULAR ASSIST DEVICE, IMPLANTABLE IN
RPLCMT XTRCORP VAD 1/BIVENTR PUMP 1/EA PUMP
RPLCMT VAD PMP IMPLTBL ICORP 1 VNTR W/O CARD BYP
RPLCMT VAD PMP IMPLTBL ICORP 1 VNTR W/CARD BYP
ECMO/ECLS RMVL PRPH CANNULA OPEN 6 YRS & OLDER
ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH-5 YRS
ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER
ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS
INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS
RMVL LEFT HEART VENT BY THORACIC INCIS ECMO/ECLS
INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY
INSJ PERQ VAD TRNSPTAL W/IMAGE ART&VENOUS ACCESS
REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION
REPOSITION VAD W/IMAGING DIFFERENT SESSION
UNLISTED PROC, CARDIAC SURGERY
EMBOLECTOMY/THROMBECTOMY; CAROTID/SUBCLAVIAN/INNOM
EMBOLECTOMY/THROMBECTOMY; INNOMINATE/SUBCLAVIAN AR
EMBOLECTOMY/THROMBECTOMY; AXILLARY/BRACHIAL/INNOMI
EMBOLECTOMY/THROMBECTOMY; RADIAL/ULNAR ARTERY, ARM
EMBOLECTOMY/THROMBECTOMY; RENAL/CELIAC/MESENTERY/A
EMBOLECTOMY/THROMBECTOMY; FEMOROPOPLITEAL/AORTOILI
EMBOLECTOMY/THROMBECTOMY; POPLITEAL-TIBIO-PERONEAL
THROMBECTOMY, DIRECT/W/CATHETER; VENA CAVA, ILIAC
THROMBECTOMY, DIRECT/W/CATHETER; VENA CAVA, ILIAC,
THROMBECTOMY, DIRECT/W/CATHETER; VENA CAVA/ILIAC/F
THROMBECTOMY, DIRECT/W/CATHETER; SUBCLAVIAN VEIN,
THROMBECTOMY, DIRECT/W/CATHETER; AXILLARY AND SUBC
VALVULOPLASTY, FEMORAL VEIN
RECONSTRUCTION, VENA CAVA, ANY METHOD
DYSPNEA SCRND NO-MILD DYSP
VENOUS VALVE TRANSPOSITION, ANY VEIN DONOR
DYSPNEA SCRND MOD-HIGH DYSP
CROSS-OVER VEIN GRAFT TO VENOUS SYSTEM
DYSPNEA NOT SCREENED
SAPHENOPOPLITEAL VEIN ANASTOMOSIS
TB SCRNG DONE-INTERPD 6MON
RA DISEASE ACTIVITY LOW
RA DISEASE ACTIVITY MOD
RA DISEASE ACTIVITY HIGH
DISEASE PROGN RA POOR DOCD
DISEASE PROGN RA GOOD DOCD
REPAIR, ENDOVASC, INFRARENAL ABDOM AORTIC ANEURYSM
REPAIR, ENDOVASC, INFRARENAL ABDOM AORTIC ANEURYSM
ENDOVASCULAR REPAIR OF INFRARENAL ABD AORTIC ANEUR
REPAIR, ENDOVASC, INFRARENAL ABDOM AORTIC ANEURYSM
REPAIR, ENDOVASC, INFRARENAL ABDOM AORTIC ANEURYSM
TRANSCATH PLCMT PHYSIOLGIC SENSOR ANEURYSMAL SAC
PLACEMENT, ENDOVASC, ILIAC ARTERY OCCLUSION DEVICE
OPEN EXPOSURE, FEM ARTERY, ENDOVASC PROSTH DELIVER
PLACEMENT, FEM-FEM PROSTH GRAFT DURING ENDOVASCULA
OPEN EXPOSURE, ILIAC ART, ENDOVASC PROSTH/ILIAC OC
PROX/DISTAL EXTN PROSTH, INFRARENAL ABDOM AORTIC/I
PROX/DISTAL EXTN PROSTH, INFRARENAL ABDOM AORTIC/I
OPEN REPAIR, INFRARENAL AORTIC ANUERS/DISSEC, AND
OPEN REPAIR, INFRARENAL AORTIC ANEUR/DISSEC AND RE
OPEN REPAIR, INFRARENAL AORTIC ANEUR/DISSEC AND RE
OPEN ILIAC ARTERY EXPOSE W/CONDUIT, INFRARENAL AOR
OPEN BRACHIAL ARTERY EXPOSE, DEPLOY INFRARENAL AOR
PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT
ENDOVASC VISCER AORTA REPAIR FENEST 1 ENDOGRAFT
ENDOVASC VISCER AORTA REPAIR FENEST 2 ENDOGRAFT
ENDOVASC VISCER AORTA REPAIR FENEST 3 ENDOGRAFT
ENDOVASC VISCER AORTA REPR FENEST 4+ ENDOGRAFT
VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS
VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS
VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS
VISCER AND INFRARENAL ABDOM AORTA 4+ PROSTHESIS
EVASC RPR ILIAC ART ILIO-ILIAC PROSTHESIS
HISTORY - AIDS-DEFINING COND
HIV UNSURE BABY OF HIV+MOMS
HISTORY OF NADIR CD4+ CELL COUNT <350 CELLS/MM3
NO HIST NADIR CD4+ CELL CNT <350 OR AIDS-INDICA
CD4+ CELL COUNT <200 CELLS/MM
CD4+ CELL COUNT 200 - 499 CELLS/MM (HIV)
CD4+ CELL COUNT /EQUAL 500 CELLS/MM
CD4+ CELL PERCENTAGE <15%
CD4+ CELL PERCENTAGE >=15%
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT; R
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
CD4+CELL CNT/CD4+CELL % DOCD AS DONE
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT INS
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2010
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2009
1/1/2004
1/1/2009
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
Y
N
Y
N
N
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
3502F
3503F
35045
35081
35082
35091
35092
35102
35103
3510F
35111
35112
3511F
35121
35122
3512F
35131
35132
3513F
35141
35142
3514F
35151
35152
3515F
3517F
35180
35182
35184
35188
35189
35190
35201
35206
35207
3520F
35211
35216
35221
35226
35231
35236
35241
35246
35251
35256
35261
35266
35271
35276
35281
35286
35301
35302
35303
35304
35305
35306
35311
35321
35331
35341
35351
35355
35361
35363
35371
35372
35390
35400
35450
35452
35458
35460
35471
35472
35475
35476
35500
35501
35506
35508
35509
3550F
35510
35511
35512
35515
35516
35518
3551F
HIV RNA VIRAL LOAD <LIMITS OF QUANTIF
HIV RNA VRL LDNOT<LMTS QUNTF
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
DOC THAT TB SCREENING DONE-RESULTS INTERPRETED
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
CHLAMYDIA/GONORRHEA TSTS DOCD AS DONE
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
SYPHILIS SCREENING DOCUMENTED AS DONE
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
HEPATITIS B SCREENING DOCUMENTED AS PERFORMED
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
HEP C SCREENING DOCD AS PERFORMED
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
REPAIR DIRECT/FALSE ANEURYSM/EXCISION AND GRAFT IN
PATIENT HAS DOCUMENTED IMMUNITY TO HEP C
HBV STATUS ASSESSED W/ RESULTS IN 1 YR
REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; HEAD AND
REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; THORAX A
REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; EXTREMIT
REPAIR, ACQUIRED/TRAUMATIC ARTERIOVENOUS FISTULA;
REPAIR, ACQUIRED/TRAUMATIC ARTERIOVENOUS FISTULA;
REPAIR, ACQUIRED/TRAUMATIC ARTERIOVENOUS FISTULA;
REPAIR BLOOD VESSEL, DIRECT; NECK
REPAIR BLOOD VESSEL, DIRECT; UPPER EXTREMITY
REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER
CLOSTRIDIUM DIFFICILE TESTING PERFORMED
REPAIR BLOOD VESSEL, DIRECT; INTRATHORACIC, W/BYPA
REPAIR BLOOD VESSEL, DIRECT; INTRATHORACIC, W/O BY
REPAIR BLOOD VESSEL, DIRECT; INTRA-ABDOMINAL
REPAIR BLOOD VESSEL, DIRECT; LOWER EXTREMITY
REPAIR BLOOD VESSEL W/VEIN GRAFT; NECK
REPAIR BLOOD VESSEL W/VEIN GRAFT; UPPER EXTREMITY
REPAIR BLOOD VESSEL W/VEIN GRAFT; INTRATHORACIC, W
REPAIR BLOOD VESSEL W/VEIN GRAFT; INTRATHORACIC, W
REPAIR BLOOD VESSEL W/VEIN GRAFT; INTRA-ABDOMINAL
REPAIR BLOOD VESSEL W/VEIN GRAFT; LOWER EXTREMITY
REPAIR BLOOD VESSEL W/GRAFT OTHER THAN VEIN; NECK
REPAIR BLOOD VESSEL W/GRAFT OTHER THAN VEIN; UPPER
REPAIR BLOOD VESSEL W/GRAFT OTHER THAN VEIN; INTRA
REPAIR BLOOD VESSEL W/GRAFT OTHER THAN VEIN; INTRA
REPAIR BLOOD VESSEL W/GRAFT OTHER THAN VEIN; INTRA
REPAIR BLOOD VESSEL W/GRAFT OTHER THAN VEIN; LOWER
THROMBOENDARTERECTOMY, W/WO PATCH GRAFT; CAROTID,
Rechanneling of artery
Rechanneling of artery
Rechanneling of artery
Rechanneling of artery
Rechanneling of artery
THROMBOENDARTERECTOMY, W/WO PATCH GRAFT; SUBCLAVIA
THROMBOENDARTERECTOMY, W/WO PATCH GRAFT; AXILLARYTHROMBOENDARTERECTOMY, W/WO PATCH GRAFT; ABDOMINAL
THROMBOENDARTERECTOMY, W/WO PATCH GRAFT; MESENTERI
THROMBOENDARTERECTOMY, W/WO PATCH GRAFT; ILIAC
THROMBOENDARTERECTOMY, W/WO PATCH GRAFT; ILIOFEMOR
THROMBOENDARTERECTOMY, W/WO PATCH GRAFT; COMBINED
THROMBOENDARTERECTOMY, W/WO PATCH GRAFT; COMBINED
THROMBOENDARTERECTOMY, W/WO PATCH GRAFT; COMMON FE
THROMBOENDARTERECTOMY, W/WO PATCH GRAFT; DEEP (PRO
REOPERATION, CAROTID, THROMBOENDARTERECTOMY, MORE
ANGIOSCOPY, NON-CORONARY, DURING THERAPEUTIC INTER
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; RENAL/OTHE
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; AORTIC
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; BRACHIOCEP
TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; VENOUS
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; RE
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS, AO
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS, BR
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS, VE
HARVEST VEIN, UPPER EXTREMITY, ONE SEGMENT, LOWER
BYPASS GRAFT, W/VEIN; CAROTID
BYPASS GRAFT, W/VEIN; CAROTID-SUBCLAVIAN
BYPASS GRAFT, W/VEIN; CAROTID-VERTEBRAL
BYPASS GRAFT, W/VEIN; CAROTID-CAROTID
LOW RISK FOR THROMBOEMBOLISM
BYPASS GRAFT, W/VEIN; CAROTID-BRACHIAL
BYPASS GRAFT, W/VEIN; SUBCLAVIAN-SUBCLAVIAN
BYPASS GRAFT, W/VEIN; SUBCLAVIAN-BRACHIAL
BYPASS GRAFT, W/VEIN; SUBCLAVIAN-VERTEBRAL
BYPASS GRAFT, W/VEIN; SUBCLAVIAN-AXILLARY
BYPASS GRAFT, W/VEIN; AXILLARY-AXILLARY
INTERMEDIATE RISK FOR THROMBOEMBOLISM
10/1/2008
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
10/1/2008
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2008
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
35521
35522
35523
35525
35526
3552F
35531
35533
35535
35536
35537
35538
35539
35540
35556
35558
3555F
35560
35563
35565
35566
35570
35571
35572
35583
35585
35587
35600
35601
35606
35612
35616
35621
35623
35626
35631
35632
35633
35634
35636
35637
35638
35642
35645
35646
35647
35650
35654
35656
35661
35663
35665
35666
35671
35681
35682
35683
35685
35686
35691
35693
35694
35695
35697
35700
35701
3570F
35721
3572F
3573F
35741
35761
35800
35820
35840
35860
35870
35875
35876
35879
35881
35883
35884
35901
35903
35905
35907
36000
36002
36005
36010
BYPASS GRAFT, W/VEIN; AXILLARY-FEMORAL
BYPASS GRAFT, W/VEIN; AXILLARY-BRACHIAL
BYPASS GRAFT WITH VEIN BRACHIAL-ULNAR/-RADIAL
BYPASS GRAFT, W/VEIN; BRACHIAL-BRACHIAL
BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE
HIGH RISK FOR THROMBOEMBOLISM
BYPASS GRAFT, W/VEIN; AORTOCELIAC/AORTOMESENTERIC
BYPASS GRAFT, W/VEIN; AXILLARY-FEMORAL-FEMORAL
BYPASS GRAFT WITH VEIN HEPATORENAL
BYPASS GRAFT, W/VEIN; SPLENORENAL
Artery bypass graft
Artery bypass graft
Artery bypass graft
Artery bypass graft
BYPASS GRAFT, W/VEIN; FEMORAL-POPLITEAL
BYPASS GRAFT, W/VEIN; FEMORAL-FEMORAL
PT HAD INR MEASUREMENT PERFORMED
BYPASS GRAFT, W/VEIN; AORTORENAL
BYPASS GRAFT, W/VEIN; ILIOILIAC
BYPASS GRAFT, W/VEIN; ILIOFEMORAL
BYPASS GRAFT, W/VEIN; FEMORAL-ANT TIBIAL/POST TIBI
BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL
BYPASS GRAFT, W/VEIN; POPLITEAL-TIBIAL, -PERONEAL
HARVEST, FEMOROPOPLITEAL VEIN, ONE SEGMENT, VASCUL
IN-SITU VEIN BYPASS; FEMORAL-POPLITEAL
IN-SITU VEIN BYPASS; FEMORAL-ANTERIOR TIBIAL, POST
IN-SITU VEIN BYPASS; POPLITEAL-TIBIAL, PERONEAL
HARVEST, UPPER EXTREMITY ART, 1 SEGMENT, CORONARY
BYPASS GRAFT, W/OTHER THAN VEIN; CAROTID
BYPASS GRAFT, W/OTHER THAN VEIN; CAROTID-SUBCLAVIA
BYPASS GRAFT, W/OTHER THAN VEIN; SUBCLAVIAN-SUBCLA
BYPASS GRAFT, W/OTHER THAN VEIN; SUBCLAVIAN-AXILLA
BYPASS GRAFT, W/OTHER THAN VEIN; AXILLARY-FEMORAL
BYPASS GRAFT, W/OTHER THAN VEIN; AXILLARY-POPLITEA
BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE
BYPASS GRAFT, W/OTHER THAN VEIN; AORTOCELIAC, AORT
BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC
BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC
BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL
BYPASS GRAFT, W/OTHER THAN VEIN; SPLENORENAL (SPLE
Artery bypass graft
Artery bypass graft
BYPASS GRAFT, W/OTHER THAN VEIN; CAROTID-VERTEBRAL
BYPASS GRAFT, W/OTHER THAN VEIN; SUBCLAVIAN-VERTEB
BYPASS GRAFT, W/OTHER THAN VEIN; AORTOBIFEMORAL
BYPASS GRAFT, W/OTHER THAN VEIN; AORTOFEMORAL
BYPASS GRAFT, W/OTHER THAN VEIN; AXILLARY-AXILLARY
BYPASS GRAFT, W/OTHER THAN VEIN; AXILLARY-FEMORALBYPASS GRAFT, W/OTHER THAN VEIN; FEMORAL-POPLITEAL
BYPASS GRAFT, W/OTHER THAN VEIN; FEMORAL-FEMORAL
BYPASS GRAFT, W/OTHER THAN VEIN; ILIOILIAC
BYPASS GRAFT, W/OTHER THAN VEIN; ILIOFEMORAL
BYPASS GRAFT, W/OTHER THAN VEIN; FEMORAL-ANT TIBIA
BYPASS GRAFT, W/OTHER THAN VEIN; POPLITEAL-TIBIAL/
BYPASS GRAFT; COMPOSITE/PROSTHETIC/VEIN
BYPASS GRAFT; AUTOGENOUS COMPOSITE, 2 SEGMENTS, 2
BYPASS GRAFT; AUTOGENOUS COMPOSITE, 3 OR MORE SEGM
PLACEMENT, VEIN PATCH/CUFF, DISTAL ANASTOMOSIS BYP
CREATION, DISTAL ARTERIOVENOUS FISTULA, LOWER EXTR
TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO
TRANSPOSITION AND/OR REIMPLANTATION; VERTEBRAL TO
TRANSPOSITION AND/OR REIMPLANTATION; SUBCLAVIAN TO
TRANSPOSITION AND/OR REIMPLANTATION; CAROTID TO SU
REIMPLANTATION, VISCERAL ARTERY-INFRARENAL AORTIC
REOPERATION, FEMORAL-POPLITEAL/FEMORAL/OTHER DISTA
EXPLORATION, NOT FOLLOWED, SURGICAL REPAIR, W/WO A
RPRT BONE SCINT X-REF W/ X-RAY 4 SAME REGION
EXPLORATION, NOT FOLLOWED, SURGICAL REPAIR, W/WO A
PT CONSIDERED POSS RISK FX 4 WT-BEARING SITE
PT NOT CONSID POSS RISK FX 4 WT-BEARING SITE
EXPLORATION, NOT FOLLOWED, SURGICAL REPAIR, W/WO A
EXPLORATION, NOT FOLLOWED, SURGICAL REPAIR, W/WO A
EXPLORATION, POSTOPERATIVE HEMORRHAGE, THROMBOSIS/
EXPLORATION, POSTOPERATIVE HEMORRHAGE, THROMBOSIS/
EXPLORATION, POSTOPERATIVE HEMORRHAGE, THROMBOSIS/
EXPLORATION, POSTOPERATIVE HEMORRHAGE, THROMBOSIS/
REPAIR, GRAFT-ENTERIC FISTULA
THROMBECTOMY, ARTERIAL/VENOUS GRAFT (OTHER THAN HE
THROMBECTOMY, ARTERIAL/VENOUS GRAFT (OTHER THAN HE
REVISION, LOWER EXTREMITY ARTERY BYPASS W/O THROMB
REVISION, LOWER EXTREMITY ARTERY BYPASS W/O THROMB
Revise graft w/nonauto graft
Revise graft w/vein
EXCISION, INFECTED GRAFT; NECK
EXCISION, INFECTED GRAFT; EXTREMITY
EXCISION, INFECTED GRAFT; THORAX
EXCISION, INFECTED GRAFT; ABDOMEN
INTRODUCTION, NEEDLE/INTRACATHETER, VEIN
INJECTION, (THROMBIN) PERCUTANEOUS TREATMENT EXTRE
INJECTION PROC, EXTREMITY, VENOGRAPHY, W/INTRO NEE
INTRODUCTION, CATHETER, SUPERIOR/INFERIOR VENA CAV
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2008
1/1/2004
10/1/2008
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
36011
36012
36013
36014
36015
36100
36120
36140
36147
36148
36160
36200
36215
36216
36217
36218
36221
36222
36223
36224
36225
36226
36227
36228
36245
36246
36247
36248
36251
36252
36253
36254
36260
36261
36262
36299
36400
36405
36406
36410
36415
36416
36420
36425
36430
36440
36450
36455
36460
36468
36470
36471
36475
36476
36478
36479
36481
36500
3650F
36510
36511
36512
36513
36514
36515
36516
36522
36555
36556
36557
36558
36560
36561
36563
36565
36566
36568
36569
36570
36571
36575
36576
36578
36580
36581
36582
36583
36584
36585
36589
36590
SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; 1ST O
SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; OR M
INTRODUCTION, CATHETER, RIGHT HEART/MAIN PULMONARY
SELECTIVE CATHETER PLACEMENT, LEFT/RIGHT PULMONARY
SELECTIVE CATHETER PLACEMENT, SEGMENTAL/SUBSEGMENT
INTRODUCTION, NEEDLE/INTRACATHETER; CAROTID/VERTEB
INTRODUCTION, NEEDLE/INTRACATHETER; RETROGRADE BRA
INTRODUCTION, NEEDLE/INTRACATHETER; EXTREMITY ARTE
INTRO NDL/CATH AV SHUNT IST ACCESS W/ RAD EVAL
INTRO NDL/CATH AV SHUNT ADDL ACCESS THER IVNTJ
INTRODUCTION, NEEDLE/INTRACATHETER; AORTIC, TRANSL
INTRODUCTION OF CATHETER, AORTA
SELECTIVE CATHETERIZATION, ARTERIAL; 1ST ORDER THO
SELECTIVE CATHETERIZATION, ARTERIAL; 2ND ORDER THO
SELECTIVE CATHETERIZATION, ARTERIAL; 3RD OR MORE O
SELECTIVE CATHETERIZATION, ARTERIAL; ADDL 2ND OR M
NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART
SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART
SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART
SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART
SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY
SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY
SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC
SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT
SELECTIVE CATHETERIZATION, ARTERIAL; 1ST ORDER ABD
SELECTIVE CATHETERIZATION, ARTERIAL; 2ND ORDER ABD
SELECTIVE CATHETERIZATION, ARTERIAL; 3RD OR MORE A
SELECTIVE CATHETERIZATION, ARTERIAL; ADDL 2ND OR M
SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UNI
SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BILAT
SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTERY/S&I UNI
SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTER/S&I BILAT
INSERTION, IMPLANTABLE INTRA-ARTERIAL INFUSION PUM
REVISION, IMPLANTED INTRA-ARTERIAL INFUSION PUMP
REMOVAL, IMPLANTED INTRA-ARTERIAL INFUSION PUMP
UNLISTED PROC, VASCULAR INJECTION
VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN
VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN
VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN
VNPNXR 3 YEARS/> PHYS/QHP SKILL
COLLECTION, VENOUS BLOOD, VENIPUNCTURE
COLLECTION, CAPILLARY BLOOD SPECIMEN
VENIPUNCTURE, CUTDOWN; UNDER AGE 1
VENIPUNCTURE, CUTDOWN; OVER AGE 1
TRANSFUSION, BLOOD/BLOOD COMPONENTS
PUSH TRANSFUSION, BLOOD, AGE 2OR UNDER
EXCHANGE TRANSFUSION, BLOOD; NEWBORN
EXCHANGE TRANSFUSION, BLOOD; OTHER THAN NEWBORN
TRANSFUSION, INTRAUTERINE, FETAL
SINGLE/MULTIPLE INJECTIONS, SCLEROSING SOLUTIONS,
INJECTION, SCLEROSING SOLUTION; SINGLE VEIN
INJECTION, SCLEROSING SOLUTION; MULTIPLE VEINS, SA
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, E
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, E
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, L
PERCUTANEOUS PORTAL VEIN CATHETERIZATION, ANY METH
VENOUS CATHETERIZATION, SELECTIVE ORGAN BLOOD SAMP
ELECTROENCEPHALOGRAM ORDERED RVWD OR REQ
CATHETERIZATION, UMBILICAL VEIN, DX/THERAPY, NEWBO
THERAPEUTIC APHERESIS; WHITE BLOOD CELLS
THERAPEUTIC APHERESIS; RED BLOOD CELLS
THERAPEUTIC APHERESIS; PLATELETS
THERAPEUTIC APHERESIS; PLASMA PHERESIS
THERAPEUTIC APHERESIS; W/EXTRACORPOREAL IMMUNOADSO
THERAPEUTIC APHERESIS; W/EXTRACORPRL SELECTVE ADSO
PHOTOPHERESIS, EXTRACORPOREAL
INSERTION, NON-TUNNELED CENTRALLY INSERTED VENOUS
INSERTION, NON-TUNNELED CENTRALLY INSERTED VENOUS
INSERTION, TUNNELED CENTRALLY INSERTED VENOUS CATH
INSERTION, TUNNELED CENTRALLY INSERTED VENOUS CATH
INSERTION, TUNNELED CENTRALLY INSERTED VENOUS ACCE
INSERTION, TUNNELED CENTRALLY INSERTED VENOUS ACCE
INSERTION, TUNNELED CENTRALLY INSERTED VENOUS ACCE
INSERTION, TUNNELED VENOUS ACCESS DEVICE, REQ 2 CA
INSERTION, TUNNELED VENOUS ACCESS DEVICE, REQ 2 CA
INSERTION, PERIPHERAL CENTRAL VENOUS CATHETER, W/O
INSERTION, PERIPHERAL CENTRAL VENOUS CATHETER, W/O
INSERTION, PERIPHERAL CENTRAL VENOUS ACCESS DEVICE
INSERTION, PERIPHERAL CENTRAL VENOUS ACCESS DEVICE
REPAIR, TUNNELED/NON-TUNNELED CVA CATHETER, W/O SU
REPAIR, CVA DEVICE, W/SUBQ PORT/PUMP
REPLACEMENT, CATHETER, CVA DEVICE, W/SUBQ PORT/PUM
REPLACEMENT, COMPLETE, NON-TUNNELED CENTRAL VENOUS
REPLACEMENT, COMPLETE, TUNNELED CENTRAL VENOUS CAT
REPLACEMENT, COMPLETE, TUNNELED CVA DEVICE, W/SUBQ
REPLACEMENT, COMPLETE, TUNNELED CVA DEVICE, W/SUBQ
REPLACEMENT, COMPLETE, PERIPHERAL CENTRAL VENOUS C
REPLACEMENT, COMPLETE, PERIPHERAL CVA DEVICE, W/SU
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, W/O S
REMOVAL OF TUNNELED CVA DEVICE, WITH SUBQ PORT OR
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
36591
36592
36593
36595
36596
36597
36598
36600
36620
36625
36640
36660
36680
36800
36810
36815
36818
36819
36820
36821
36823
36825
36830
36831
36832
36833
36835
36838
36860
36861
36870
3700F
37140
37145
37160
37180
37181
37182
37183
37184
37185
37186
37187
37188
37191
37192
37193
37195
37197
37200
37202
3720F
37211
37212
37213
37214
37215
37216
37217
37218
37220
37221
37222
37223
37224
37225
37226
37227
37228
37229
37230
37231
37232
37233
37234
37235
37236
37237
37238
37239
37241
37242
37243
37244
37250
37251
37252
37253
3725F
37500
37501
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE
COLLECT BLOOD FROM CATHETER VENOUS NOS
DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH
MECHANICAL REMOVAL, PERICATHETER OBSTRUCTIVE MATER
MECHANICAL REMOVAL, INTRALUMINAL OBSTRUCTIVE MATER
REPOSITIONING, PREVIOUSLY PLACED CV CATHETER, W/FL
CONTRACT INJ; INCLUDING FLUOROSCOPY; IMAGE DOCUMEN
ARTERIAL PUNCTURE, WITHDRAWAL, BLOOD, DX
ARETRIAL CATHETERIZATION OR CANNULATION FOR SAMPLI
ARTERIAL CATHETERIZATION/CANNULATION, MONITORING/T
ARTERIAL CATHETERIZATION, PROLONGED INFUSION THERA
CATHETERIZATION, UMBILICAL ARTERY, NEWBORN, DX/THE
PLACEMENT, NEEDLE, INTRAOSSEOUS INFUSION
INSERTION, CANNULA, HEMODIALYSIS (SEP PROC); VEIN
INSERTION, CANNULA, HEMODIALYSIS (SEP PROC); AV, E
INSERTION, CANNULA, HEMODIALYSIS (SEP PROC); AV, E
ARTERIOVENOUS ANASTOMOSIS, OPEN;BY UPPER ARM CEPHA
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASI
ARTERIOVENOUS ANASTOMOSIS, OPEN; FOREARM VEIN TRAN
ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE
INSERT, CANNULA, ISOLATED EXTRACORPOREAL CIRCULATI
CREATION, AV FISTULA, NON-DIRECT (SEP PROC); AUTOG
CREATION, AV FISTULA, NON-DIRECT (SEP PROC); NON-A
THROMBECTOMY, OPEN, AV FISTULA, W/O REVISION, AUTO
REVISION, OPEN, AV FISTULA; W/O THROMBECTOMY, AUTO
REVISION, OPEN, AV FISTULA; W/THROMBECTOMY, AUTOGE
INSERTION, THOMAS SHUNT (SEP PROC)
DISTAL REVASCULARIZATION AND INTERVAL LIGATION, UP
EXTERNAL CANNULA DECLOTTING (SEP PROC); W/O BALLOO
EXTERNAL CANNULA DECLOTTING (SEP PROC); W/BALLOON
THROMBEC, PERCUT, AV FIST, AUTOG/NONAUTOG GRAFT (M
PSYCHIATRIC DISORDERS/DISTURBANCES ASSESSED
VENOUS ANASTOMOSIS, OPEN; PORTOCAVAL
VENOUS ANASTOMOSIS, OPEN; RENOPORTAL
VENOUS ANASTOMOSIS, OPEN; CAVALMESENTERIC
VENOUS ANASTOMOSIS, OPEN; SPLENORENAL, PROXIMAL
VENOUS ANASTOMOSIS, OPEN; SPLENORENAL, DISTAL
INSERTION, TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC
REVISION, TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC S
PRIMARY PERCUTANEOUS TRANSLUMINAL MECH THROBECTOMY
PRIMARY PERCUTANEOUS TRANSLUMINAL MECH THROBECTOMY
SECONDARY PERCUTANEOUS TRANSLUMINAL THROMBECTOMY'
PERCUTANEOUS TRANSLUMINAL MECH THROMBECTMY; VEINS,
PERCUTANEOUS TRANSLUMINAL MECH THROMBECTOMY; VEINS
INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I
REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
THROMBOLYSIS, CEREBRAL, IV INFUSION
PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING
TRANSCATHETER BX
TRANSCATHETER THERAPY, INFUSION NON-THROMBOLYSIS
COGNITIVE IMPAIRMENT/DYSFUNCTION ASSESSED
THROMBOLYSIS ARTERIAL INFUSION W/IMAGING INIT TX
THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX
THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX
CESSATION THROMBOLYTIC THRPY W/CATHETER REMOVAL
TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENTS WI
TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENTS WI
TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE
TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE
REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL
REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOP UNI
REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL
REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSI VSL
REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI
REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL
REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL
REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL
REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI
REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL
REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL
REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL
REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL
REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL
REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL
REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL
OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL
OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL
OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST
OPEN/PERQ PLACEMT INTRAVASC STENT SAME EA ADDL
VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I
VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT
VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
INTRAVASCULAR ULTRASOUND (NON-CORONARY) DURING DX/
INTRAVASCULAR ULTRASOUND (NON-CORONARY) DURING DX/
INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION A
INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION A
SCREENING FOR DEPRESSION PERFORMED
VASCULAR ENDOSCOPY, SURGICAL, W/LIGATION, PERFORAT
UNLISTED VASCULAR ENDOSCOPY PROC
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2013
1/1/2004
1/1/2004
10/1/2010
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2014
1/1/2015
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2012
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
3750F
3751F
3752F
3753F
3754F
3755F
37565
3756F
3757F
3758F
3759F
37600
37605
37606
37607
37609
3760F
37615
37616
37617
37618
37619
3761F
3762F
3763F
37650
37660
37700
37718
37722
37735
37760
37761
37765
37766
37780
37785
37788
37790
37799
38100
38101
38102
38115
38120
38129
38200
38204
38205
38206
38207
38208
38209
38210
38211
38212
38213
38214
38215
38220
38221
38230
38232
38240
38241
38242
38243
38300
38305
38308
38380
38381
38382
38500
38505
38510
38520
38525
38530
38542
38550
38555
38562
38564
38570
38571
38572
38589
38700
38720
38724
PT NOT RCVNG DOSE CORTICOSTEROIDS >/= 10MG/DAY
ELECTRODIAG STUDIES DSP DOCD RVWD W/IN 6 MONTHS
ELECTRODIAG STUDIES DSP NOT DOCD RVWD W/IN 6 MON
PT HAS CLINICAL SYMP+SIGNS NEUROPATHY W/ CAUSE
SCREENING TSTS DIABETES MELLITUS RVWD RQSTD ORD
COGNITIVE+BEHAVIORAL IMPAIRMENT SCRNG PERFORMED
LIGATION, INT JUGULAR VEIN
PT HAS PSEUDOBULBAR AFFECT/SIALORRHEA/ALS SYMP
NO PSEUDOBULBAR AFFECT/SIALORRHEA/ALS SYMP
PULM FUNC TESTING/PEAK COUGH EXPIRATORY FLOW
PT SCRND DYSPHAGIA+WT LOSS+IMPAIRED NUTRITION
LIGATION; EXT CAROTID ARTERY
LIGATION; INT/COMMON CAROTID ARTERY
LIGATION; INT/COMMON CAROTID ARTERY, W/GRADUAL OCC
LIGATION/BANDING, ANGIOACCESS ARTERIOVENOUS FISTUL
LIGATION/BX, TEMPORAL ARTERY
DYSPHAG+WT LOSS+IMPAIRED NUTRITION
LIGATION, MAJOR ARTERY; NECK
LIGATION, MAJOR ARTERY; CHEST
LIGATION, MAJOR ARTERY; ABDOMEN
LIGATION, MAJOR ARTERY; EXTREMITY
INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I
NO DYSPHAG+WT LOSS+IMPAIRED NUTRITION
PATIENT IS DYSARTHRIC
PATIENT IS NOT DYSARTHRIC
LIGATION, FEMORAL VEIN
LIGATION, COMMON ILIAC VEIN
LIGATION AND DIVISION, LONG SAPHENOUS VEIN, SAPHEN
LIGATION, DIVISION, AND STRIPPING, SHORT SAPHENOUS
LIGATION, DIVISION, AND STRIPPING, LONG SAPHENOUS
LIGATN/DIVISN/STRPG, LNG/SHRT SAPHENOUS VEINS W/RA
LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG
LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG
STAB PHLEBECTOMY, VARICOSE VEINS, 1 EXTREMITY; LES
STAB PHLEBECTOMY, VARICOSE VEINS, 1 EXTREMITY; OVE
LIGATION/ DIVISION, SHORT SAPHENOUS VEIN, SAPHENOP
LIGATION/DIVISION/EXCISION, VARICOSE VEIN CLUSTER(
PENILE REVASCULARIZATION, ARTERY, W/WO VEIN GRAFT
PENILE VENOUS OCCLUSIVE PROC
UNLISTED PROC, VASCULAR SURGERY
SPLENECTOMY; TOTAL (SEP PROC)
SPLENECTOMY; PARTIAL (SEP PROC)
SPLENECTOMY; TOTAL, EN BLOC, EXTENSIVE DISEASE, W/
REPAIR, RUPTURED SPLEEN (SPLENORRHAPHY) W/WO PARTI
LAPAROSCOPY, SURGICAL, SPLENECTOMY
UNLISTED LAPAROSCOPY PROC, SPLEEN
INJECTION PROC, SPLENOPORTOGRAPHY
MANAGEMENT, RECIPIENT HEMATOPOIETIC PROGENITOR CEL
BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVES
BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVES
TRANSPLANT PREPARATION, HEMATOPOIETIC PROGENITOR C
TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR
TRNSP PREP HMATOP PROG THAW PREV HRV WSH PER DNR
TRANSPLANT PREP, HEMATOPOIETIC PROGENITOR CELLS; S
TRANSPLANT PREPARATION, HEMATOPOIETIC PROGENITOR C
TRANSPLANT PREPARATION, HEMATOPOIETIC PROGENITOR C
TRANSPLANT PREPARATION, HEMATOPOIETIC PROGENITOR C
TRANSPLANT PREPARATION, HEMATOPOIETIC PROGENITOR C
TRANSPLANT PREP, HEMATOIEPOTIC PROGENITOR CELLS; C
BONE MARROW; ASPIRATION ONLY
BONE MARROW BX, NEEDLE/TROCAR
BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC
BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS
TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR
TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR
ALLOGENEIC LYMPHOCYTE INFUSIONS
TRNSPLJ HEMATOPOIETIC CELL BOOST
DRAINAGE, LYMPH NODE ABSCESS/LYMPHADENITIS; SIMPLE
DRAINAGE, LYMPH NODE ABSCESS/LYMPHADENITIS; EXTENS
LYMPHANGIOTOMY/OTHER OPERATIONS ON LYMPHATIC CHANN
SUTURE AND/OR LIGATION, THORACIC DUCT; CERVICAL AP
SUTURE AND/OR LIGATION, THORACIC DUCT; THORACIC AP
SUTURE AND/OR LIGATION, THORACIC DUCT; ABDOMINAL A
BX/EXCISION, LYMPH NODE(S); SUPERFICIAL
BX/EXCISION, LYMPH NODE(S); NEEDLE, SUPERFICIAL
BX/EXCISION, LYMPH NODE(S); OPEN, DEEP CERVICAL NO
BX/EXCISION, LYMPH NODE(S); OPEN, DEEP CERVICAL NO
BX/EXCISION, LYMPH NODE(S); OPEN, DEEP AXILLARY NO
BX/EXCISION, LYMPH NODE(S); INT MAMMARY NODE(S)
DISSECTION, DEEP JUGULAR NODE(S)
EXCISION, CYSTIC HYGROMA, AXILLARY/CERVICAL; W/O D
EXCISION, CYSTIC HYGROMA, AXILLARY/CERVICAL; W/DEE
LIMITED LYMPHADENECTOMY, STAGING (SEP PROC); PELVI
LIMITED LYMPHADENECTOMY, STAGING (SEP PROC); RETRO
LAPAROSCOPY, SURGICAL; W/RETROPERITONEAL LYMPH NOD
LAPAROSCOPY, SURGICAL; W/BILAT TOTAL PELVIC LYMPHA
LAPAROSCOPY, SURGICAL; W/BILAT TOTAL PELVIC LYMPHA
LAPAROSCOPY, LYMPHATIC SYSTEM, UNLISTED PROC
SUPRAHYOID LYMPHADENECTOMY
CERVICAL LYMPHADENECTOMY (COMPLETE)
CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DI
1/1/2012
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
Y
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
38740
38745
38746
38747
38760
38765
38770
38780
38790
38792
38794
38900
38999
39000
39010
39200
39220
39400
39401
39402
39499
39501
39503
39540
39541
39545
39560
39561
39599
4000F
4001F
4004F
4005F
4008F
4010F
4011F
4013F
4019F
4025F
4030F
4033F
4035F
4037F
4040F
4041F
4044F
4045F
4046F
4047F
4048F
40490
4049F
40500
4050F
40510
4051F
40520
40525
40527
4052F
40530
4053F
4054F
4055F
4056F
4058F
4060F
4062F
4063F
4064F
40650
40652
40654
4065F
4066F
4067F
4069F
40700
40701
40702
40720
40761
40799
40800
40801
40804
40805
40806
40808
40810
40812
AXILLARY LYMPHADENECTOMY; SUPERFICIAL
AXILLARY LYMPHADENECTOMY; COMPLETE
THORCOM THRC W/MEDSTNL & REGIONAL LMPHADEC
ABD LYMPHADENEC, REGIONAL, W/CELIAC, GASTRC, PORTL
INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, W/CLO
INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICL W/PELVIC
PELVIC LYMPHADENECTOMY, W/EXT ILIAC/HYPOGASTRIC/OB
RETROPERITONEAL TRANSABDOMINAL LYMPHADENECTOMY, EX
INJECTION PROC; LYMPHANGIOGRAPHY
INJECTION PROC; IDENTIFICATION, SENTINEL NODE
CANNULATION, THORACIC DUCT
INTRAOP SENTINEL LYMPH ID W/DYE NJX
UNLISTED PROC, HEMIC/LYMPHATIC SYSTEM
MEDIASTINOTOMY W/EXPLORATION, DRAINAGE AND REMOVAL
MEDIASTINOTOMY W/EXPLORATION, DRAINAGE AND REMOVAL
RESECTION OF MEDIASTINAL CYST
RESECTION MEDIASTINAL TUMOR
MEDIASTINOSCOPY INCL BIOPSIES WHEN PERFORMED
MEDIASTINOSCOPY; INCLUDES BIOPSY(IES) OF MEDIASTINAL MASS (EG, LYMPHOMA), WHEN P
MEDIASTINOSCOPY; WITH LYMPH NODE BIOPSY(IES) (EG, LUNG CANCER STAGING)
UNLISTED PROC, MEDIASTINUM
REPAIR, LACERATION, DIAPHRAGM, ANY APPROACH
REPAIR, NEONATAL DIAPHRAGMATIC HERNIA, W/WO CHEST
REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL)
REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL)
IMBRICATION, DIAPHRAGM, EVENTRATION, TRANSTHORACIC
RESECTION, DIAPHRAGM; W/SIMPLE REPAIR
RESECTION, DIAPHRAGM; W/COMPLEX REPAIR
UNLISTED PROC, DIAPHRAGM
TOBACCO USE CESSATION IVNTJ COUNSELING
TOBACCO USE CESSATION IVNTJ PHARMACOLOGIC THER
PT SCRND TOBACCO USE RCVD TOBACCO CESSATION TALK
PHARMACOLOGIC OSTEOPOROSIS THERAPY PRESCRIBED
BETA- BLOCKER THERAPY RXD/CURRENTLY BEING TAKEN
ACE INHIBITOR/ARB THERAPY RXD/CURRENTLY TAKEN
ORAL ANTIPLATELET TX, RX
STATIN THERAPY RXD/CURRENTLY TAKEN
Doc recpt counsl vit d/calc+
Inhaled bronchodilator rx
Oxygen therapy rx
Pulmonary rehab rec
INFLUENZA IMMUNIZATION RECOMMENDED
INFLUENZA IMMUNIZATION ORDERED OR ADMINISTERED
PNEUMOCOCCAL VACCINE ADMIN RCVD PRIOR
DOC FOR ORDER FOR CEFAZOLIN OR CEFUROXIME
DOCUMENTATION THAT AN ORDER WAS GIVEN TO DISCONTIN
Empiric antibiotic rx
DOCUMENTATION THAT ANTIBIOTICS WERE GIVEN
DOCUMENTATION OF ORDER GIVEN FOR ANTIBIOTICS
DOC ADMIN PROPHYL PAREN ANTIBIO IN 1HR B4 CUT
BX, LIP
DOCUMENTATION THAT AN ORDER WAS GIVEN TO DISCONTIN
VERMILIONECTOMY (LIP SHAVE), W/MUCOSAL ADVANCEMENT
HYPERTENSION PLAN OF CARE DOCUMENTED
EXCISION, LIP; TRANSVERSE WEDGE EXCISION W/PRIMARY
Referred for an AV fistula
EXCISION, LIP; V-EXCISION W/PRIMARY DIRECT LINEAR
EXCISION, LIP; FULL THICKNESS, RECONSTRUCTION W/LO
EXCISION, LIP; FULL THICKNESS, RECONSTRUCTION W/CR
Hemodialysis via AV fistula
RESECTION, LIP, MORE THAN ONE-FOURTH, W/O RECONSTR
Hemodialysis via AV graft
Hemodialysis via catheter
Pt. rcvng periton dialysis
Approp. oral rehyd. Recommended
Ped gastro ed given, caregvr
PSYCHOTHERPAY SERVICES PROVIDED (MDD, MD ADOL)
PATIENT REFERRAL FOR PSYCHOTHERAPY DOCUMENTED ( MD
ANTIDEP RXTHXY CONSIDERED AND NOT RXD
ANTIDEPRESSANT PHARMACOTHERAPY PRESCRIBED (MDD, MD
REPAIR LIP, FULL THICKNESS; VERMILION ONLY
REPAIR LIP, FULL THICKNESS; UP TO HALF VERTICAL HE
REPAIR LIP, FULL THICKNESS; OVER ONE-HALF VERTICAL
Antipsychotic rx
ECT provided
Pt referral for ECT documented
VENOUS THROMBOEMBOLISM (VTE) PROPHYLAXIS RCVD
PLASTIC REPAIR, CLEFT LIP/NASAL DEFORMITY; PRIMARY
PLASTIC REPAIR, CLEFT LIP/NASAL DEFORMITY; PRIMARY
PLASTIC REPAIR, CLEFT LIP/NASAL DEFORMITY; PRIMARY
PLASTIC REPAIR, CLEFT LIP/NASAL DEFORMITY; SECONDA
PLASTIC REPAIR, CLEFT LIP/NASAL DEFORMITY; W/CROSS
UNLISTED PROC, LIPS
DRAINAGE, ABSCESS, CYST, HEMATOMA, VESTIBULE, MOUT
DRAINAGE, ABSCESS, CYST, HEMATOMA, VESTIBULE, MOUT
REMOVAL, EMBEDDED FB, VESTIBULE, MOUTH; SIMPLE
REMOVAL, EMBEDDED FB, VESTIBULE, MOUTH; COMPLICATE
INCISION, LABIAL FRENUM (FRENOTOMY)
BX, VESTIBULE, MOUTH
EXCISION, LESION, MUCOSA AND SUBMUCOSA, VESTIBULE,
EXCISION, LESION, MUCOSA AND SUBMUCOSA, VESTIBULE,
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2007
1/1/2012
1/1/2012
1/1/2004
1/1/2012
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2008
1/1/2009
1/1/2007
1/1/2009
1/1/2009
1/1/2010
1/1/2004
1/1/2009
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
10/1/2009
1/1/2010
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
40814
40816
40818
40819
40820
40830
40831
40840
40842
40843
40844
40845
4086F
40899
41000
41005
41006
41007
41008
41009
4100F
41010
41015
41016
41017
41018
41019
41100
41105
41108
41110
41112
41113
41114
41115
41116
41120
41130
41135
41140
41145
41150
41153
41155
4124F
41250
41251
41252
4140F
4142F
4144F
4145F
4148F
4149F
41500
41510
41512
41520
41530
4153F
41599
4163F
4164F
4165F
4167F
4168F
4169F
4171F
4172F
4174F
4175F
4176F
4177F
4178F
4179F
41800
41805
41806
4180F
4181F
41820
41821
41822
41823
41825
41826
41827
41828
4182F
41830
41850
EXCISION, LESION, MUCOSA AND SUBMUCOSA, VESTIBULE,
EXCISION, LESION, MUCOSA AND SUBMUCOSA, VESTIBULE,
EXCISION, MUCOSA, VESTIBULE, MOUTH AS DONOR GRAFT
EXCISION, FRENUM, LABIAL/BUCCAL (FRENUMECTOMY, FRE
DESTRUCTION, LESION/SCAR, MOUTH, PHYSICAL METHOD
CLOSURE, LACERATION, VESTIBULE, MOUTH; 2.5 CM OR L
CLOSURE, LACERATION, VESTIBULE, MOUTH; OVER 2.5 CM
VESTIBULOPLASTY; ANTERIOR
VESTIBULOPLASTY; POSTERIOR, UNILAT
VESTIBULOPLASTY; POSTERIOR, BILAT
VESTIBULOPLASTY; ENTIRE ARCH
VESTIBULOPLASTY; COMPLEX (W/RIDGE EXTENSION, MUSCL
ASPIRIN OR CLOPIDOGREL PRESCRIBED
UNLISTED PROC, VESTIBULE, MOUTH
INTRAORAL INCISION AND DRAINAGE, ABSCESS/CYST/HEMA
INTRAORAL INCISION AND DRAINAGE, ABSCESS/CYST/HEMA
INTRAORAL INCISION AND DRAIN, ABSCESS/CYST/HEMATOM
INTRAORAL INCISION AND DRAINAGE, ABSCESS/CYST/HEMA
INTRAORAL INCISION AND DRAINAGE, ABSCESS/CYST/HEMA
INTRAORAL INCISION AND DRAINAGE, ABSCESS/CYST/HEMA
Bisphosphonate therapy, intravenous, ordered or received (HEM)
INCISION, LINGUAL FRENUM (FRENOTOMY)
EXTRAORAL INCISION AND DRAINAGE, ABSCESS/CYST/HEMA
EXTRAORAL INCISION AND DRAINAGE, ABSCESS/CYST/HEMA
EXTRAORAL INCISION AND DRAINAGE, ABSCESS/CYST/HEMA
EXTRAORAL INCISION AND DRAINAGE, ABSCESS/CYST/HEMA
PLACEMENT NEEDLE HEAD/NECK RADIOELEMENT APPLICAT
BX, TONGUE; ANTERIOR TWO-THIRDS
BX, TONGUE; POSTERIOR ONE-THIRD
BX, MOUTH, FLOOR
EXCISION, LESION, TONGUE W/O CLOSURE
EXCISION, LESION, TONGUE W/CLOSURE; ANTERIOR TWO-T
EXCISION, LESION, TONGUE W/CLOSURE; POSTERIOR ONEEXCISION, LESION, TONGUE W/CLOSURE; W/LOCAL TONGUE
EXCISION, LINGUAL FRENUM (FRENECTOMY)
EXCISION, LESION, MOUTH FLOOR
GLOSSECTOMY; LESS THAN ONE-HALF TONGUE
GLOSSECTOMY; HEMIGLOSSECTOMY
GLOSSECTOMY; PARTIAL, W/UNILAT RADICAL NECK DISSEC
GLOSSECTOMY; COMPLETE/TOTAL, W/WO TRACHEOSTOMY, W/
GLOSSECTOMY; COMPLETE/TOTAL, W/WO TRACHEOSTOMY, W/
GLOSSECTOMY; COMPOSITE PROC, W/MOUTH FLOOR AND MAN
GLOSSECTOMY; COMPOSITE PROC, W/MOUTH FLOOR RESECTI
GLOSSECTOMY; COMPOSITE PROC, W/MOUTH FLOOR/MANDIBU
ANTIBIOTIC NEITHER PRESCRIBED NOR DISPENSED. (URI,PHAR), (A-BRONCH)
REPAIR, LACERATION 2.5 CM OR LESS; MOUTH FLOOR, AN
REPAIR, LACERATION 2.5 CMOR LESS; POSTERIOR ONE-TH
REPAIR, LACERATION, TONGUE, MOUTH FLOOR, OVER 2.6
INHALED CORTICOSTEROIDS PRESCRIBED
CORTICOSTEROID SPARING THERAPY PRESCRIBED
ALTERNATIVE LONG-TERM CONTROL MEDICATION RXD
>=2 ANTI-HYPERTENSIVE AGENTS RXD OR TAKEN
HEP A VAC INJXN ADMIN OR PREV RECVD
HEPATITIS B VACCCINE ADMIN OR PREVIOSLY RECVD
FIXATION, TONGUE, MECHANICAL, OTHER THAN SUTURE
SUTURE, TONGUE TO LIP, MICROGNATHIA
TONGUE BASE SUSPENSION PERMANENT SUTURE TQ
FRENOPLASTY
SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION
COMB PEGINTERF/RIBAVIRIN TX PRESCRIBED
UNLISTED PROC, TONGUE, MOUTH FLOOR
PT COUNS 4 TXMNT OPT PROST
ADJV HRMNL THXPY RXD
3D-CRT/IMRT) RECEIVED
HD BED TILTED 1ST DAY VENT
PT CARE ICUAND VENT W/IN 24HRS
NO PT CARE ICU/VENT IN 24HRS
PT. RCVNG ESA THXPY
PT. NOT RCVNG ESA THXPY
COUNS. POTENT. GLAUC IMPCT
VIS >= TO 20/40 W/IN 90 DAYS
TALK RE UV LIGHT PT/CRGVR
TALK PT/CRGVR RE: AREDSPREV
ANTID GLBLN RCVD W/IN 26WKS
TAMOXIFEN/AI PRESCRIBED
DRAINAGE, ABSCESS, CYST, HEMATOMA, DENTOALVEOLAR S
REMOVAL, EMBEDDED FB, DENTOALVEOLAR STRUCTURES; SO
REMOVAL, EMBEDDED FB, DENTOALVEOLAR STRUCTURES; BO
ADJV THXPYRXD/RCVD STG3A-C
CONFORMAL RADN THXPY RCVD
GINGIVECTOMY, EXCISION GINGIVA, EACH QUADRANT
OPERCULECTOMY, EXCISION PERICORONAL TISSUES
EXCISION, FIBROUS TUBEROSITIES, DENTOALVEOLAR STRU
EXCISION, OSSEOUS TUBEROSITIES, DENTOALVEOLAR STRU
EXCISION, LESION/TUMOR (EXCEPT LISTED ABOVE), DENT
EXCISION OF LESION/TUMOR DENTOALVEOLAR STRUCTURES
EXCISION, LESION/TUMOR (EXCEPT LISTED ABOVE), DENT
EXCISION, HYPERPLASTIC ALVEOLAR MUCOSA, EACH QUADR
NO CONFORMAL RADN THXPY
ALVEOLECTOMY, W/CURETTAGE, OSTEITIS/SEQUESTRECTOMY
DESTRUCTION, LESION (EXCEPT EXCISION), DENTOALVEOL
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2012
10/1/2008
10/1/2008
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2009
1/1/2008
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
4185F
4186F
41870
41872
41874
4187F
4188F
41899
4189F
4190F
4191F
4192F
4193F
4194F
4195F
4196F
42000
4200F
4201F
42100
42104
42106
42107
4210F
42120
42140
42145
42160
42180
42182
42200
42205
4220F
42210
42215
4221F
42220
42225
42226
42227
42235
42260
42280
42281
42299
42300
42305
4230F
42310
42320
42330
42335
42340
42400
42405
42408
42409
4240F
42410
42415
42420
42425
42426
4242F
42440
42450
4245F
4248F
42500
42505
42507
42509
4250F
42510
42550
4255F
4256F
42600
4260F
4261F
42650
4265F
42660
42665
4266F
4267F
4268F
42699
4269F
42700
4270F
CONTINUOUS PPI OR H2RA RCVD
NO CONT. PPI OR H2RA RCVD
PERIODONTAL MUCOSAL GRAFTING
GINGIVOPLASTY, EACH QUADRANT (SPECIFY)
ALVEOLOPLASTY, EACH QUADRANT (SPECIFY)
ANTI RHEUM DRUGTHXPYRXD/GVN
APPROP ACE/ARB TSTNG DONE
UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES
APPROP DIGOXIN TSTNG DONE
APPROP DIURETIC TSTNG DONE
APPROP ANTICONVULS TSTNG
PT RCVNGGLUCOTHERPY
PT RCVNG<10MG DAILY PREDNISO
PT RCVNG>10MG DAILY PREDNISO
PT RCVNG ANTI-RHEUM THXPY RA
PTNOT RCVNG ANTI-RHM THXPYRA
DRAINAGE, ABSCESS, PALATE, UVULA
EXTERNAL BEAM TO PROST ONLY
EXTRNL BEAM OTHER THAN PROST
BX, PALATE, UVULA
EXCISION, LESION, PALATE, UVULA; W/O CLOSURE
EXCISION, LESION, PALATE, UVULA; W/SIMPLE PRIMARY
EXCISION, LESION, PALATE, UVULA; W/LOCAL FLAP CLOS
ACE/ARB THXPY FOR >= 6 MONS
RESECTION, PALATE/EXTENSIVE RESECTION, LESION
UVULECTOMY, EXCISION, UVULA
PALATOPHARYNGOPLASTY
DESTRUCTION, LESION, PALATE/UVULA (THERMAL, CRYO/C
REPAIR, LACERATION, PALATE; UP TO 2 CM
REPAIR, LACERATION, PALATE; UP TO 2 CM/COMPLEX
PALATOPLASTY, CLEFT PALATE, SOFT AND/OR HARD PALAT
PALATOPLASTY, CLEFT PALATE, W/CLOSURE, ALVEOLAR RI
DIGOXIN THXPY FOR >= 6 MONS
PALATOPLASTY, CLEFT PALATE, W/CLOSURE, ALVEOLAR RI
PALATOPLASTY, CLEFT PALATE; MAJOR REVISION
DIURETIC THXPY FOR >= 6 MONS
PALATOPLASTY, CLEFT PALATE; SECONDARY LENGTHENING
PALATOPLASTY, CLEFT PALATE; ATTACHMENT PHARYNGEAL
LENGTHENING, PALATE, AND PHARYNGEAL FLAP
LENGTHENING, PALATE, W/ISLAND FLAP
REPAIR, ANTERIOR PALATE, W/VOMER FLAP
REPAIR, NASOLABIAL FISTULA
MAXILLARY IMPRESSION, PALATAL PROSTHESIS
INSERTION, PIN-RETAINED PALATAL PROSTHESIS
UNLISTED PROC, PALATE, UVULA
DRAINAGE, ABSCESS; PAROTID, SIMPLE
DRAINAGE, ABSCESS; PAROTID, COMPLICATED
ANTICONV THXPY FOR >= 6 MONS
DRAINAGE, ABSCESS; SUBMAXILLARY/SUBLINGUAL, INTRAO
DRAINAGE, ABSCESS; SUBMAXILLARY, EXT
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), SUBL
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), COMP
SIALOLITHOTOMY; PAROTID, EXTRAORAL/COMPLICATED INT
BX, SALIVARY GLAND; NEEDLE
BX, SALIVARY GLAND; INCISIONAL
EXCISION, SUBLINGUAL SALIVARY CYST (RANULA)
MARSUPIALIZATION, SUBLINGUAL SALIVARY CYST (RANULA
INSTR THER XRCS-DR FLLWUP PT EPSD BACK PN >12 WK
EXCISION, PAROTID TUMOR/PAROTID GLAND; LATERAL LOB
EXCISION OF PAROTID TUMOR/GLAND;LATERAL LOBE, W/DI
EXCISION, PAROTID TUMOR/PAROTID GLAND; TOTAL, W/NE
EXCISION, PAROTID TUMOR/PAROTID GLAND; TOTAL, EN B
EXCISION, PAROTID TUMOR/PAROTID GLAND; TOTAL, W/UN
SPRVSD XRCZ BK PN >12 WEEKS
EXCISION, SUBMANDIBULAR (SUBMAXILLARY) GLAND
EXCISION, SUBLINGUAL GLAND
PT INSTR RESUME NRML LIFEST
PT INSTR-NO BD REST>= 4 DAYS
PLASTIC REPAIR, SALIVARY DUCT, SIALODOCHOPLASTY; P
PLASTIC REPAIR, SALIVARY DUCT, SIALODOCHOPLASTY; S
PAROTID DUCT DIVERSION, BILAT
PAROTID DUCT DIVERSION, BILAT; W/EXCISION, BOTH SU
WRMNG 4 SURG - NORMOTHERMIA
PAROTID DUCT DIVERSION, BILAT; W/LIGATION, BOTH SU
INJECTION PROC, SIALOGRAPHY
DURATION GEN NEUR ANESTH 60 MINS/> DOC RECORD
DURATION GEN NEUR ANESTH <60 MIN DOCD RECORD
CLOSURE SALIVARY FISTULA
WOUND SRFC CULTURETECH USED
TECH OTHER THAN SURFC CULTR
DILATION SALIVARY DUCT
WET-DRY DRESSINGS RX-RECMD
DILATION AND CATHETERIZATION, SALIVARY DUCT, W/WO
LIGATION SALIVARY DUCT, INTRAORAL
NO WET-DRY DRSSINGS RX-RECMD
COMPRSSION THXPY PRESCRIBED
PT ED RE COMP THXPY RCVD
UNLISTED PROC, SALIVARY GLANDS/DUCTS
APPROPOS MTHD OFFLOADING RXD
INCISION AND DRAINAGE ABSCESS; PERITONSILLAR
PT RCVNG POTENT ANTI R-VIRAL THXPY 6 MON OR MORE
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2011
1/1/2008
1/1/2008
1/1/2008
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2004
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2009
1/1/2009
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2004
1/1/2009
1/1/2004
10/1/2008
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
4271F
42720
42725
4274F
4276F
4279F
42800
42804
42806
42808
42809
4280F
42810
42815
42820
42821
42825
42826
42830
42831
42835
42836
42842
42844
42845
42860
42870
42890
42892
42894
42900
4290F
4293F
42950
42953
42955
42960
42961
42962
42970
42971
42972
42999
4300F
4301F
43020
43030
43045
4305F
4306F
43100
43101
43107
43108
43112
43113
43116
43117
43118
43121
43122
43123
43124
43130
43135
43180
43191
43192
43193
43194
43195
43196
43197
43198
43200
43201
43202
43204
43205
43206
4320F
43210
43211
43212
43213
43214
43215
43216
43217
43220
43226
PT CVNG POT ANTI R--VIRAL THXPY <6 MON/NOT RCVNG
INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL/PAR
INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL/PAR
FLU IMMUNO ADMIND/PREVIOUSLY RCVD
POTENT ANTIRETROVIRAL THERAPY PRESCRIBED (HIV)
PCP PROPHYLAXIS RXD
BX; OROPHARYNX
BX; NASOPHARYNX, VISIBLE LESION, SIMPLE
BX; NASOPHARYNX, SURVEY, UNKNOWN PRIMARY LESION
EXCISION/DESTRUCTION, LESION, PHARYNX, ANY METHOD
REMOVAL, FB, PHARYNX
PCP PROPHYLAX RXD 3MON LOW %
EXCISION, BRANCHIAL CLEFT CYST/VESTIGE, CONFINED T
EXCISION, BRANCHIAL CLEFT CYST/VESTIGE/FISTULA, EX
TONSILLECTOMY AND ADENOIDECTOMY; UNDER AGE 12
TONSILLECTOMY AND ADENOIDECTOMY; OVER AGE 12
TONSILLECTOMY, PRIMARY/SECONDARY; UNDER AGE 12
TONSILLECTOMY, PRIMARY/SECONDARY; OVER AGE 12
ADENOIDECTOMY, PRIMARY; UNDER AGE 12
ADENOIDECTOMY, PRIMARY; OVER AGE 12
ADENOIDECTOMY, SECONDARY; UNDER AGE 12
ADENOIDECTOMY, SECONDARY; OVER AGE 12
RADICAL RESECTION, TONSIL, TONSILLAR PILLARS, AND/
RADICAL RESECTION, TONSIL, TONSILLAR PILLARS, AND/
RADICAL RESECTION, TONSIL, TONSILLAR PILLARS, AND/
EXCISION, TONSIL TAGS
EXCISION/DESTRUCTION LINGUAL TONSIL, ANY METHOD (S
LIMITED PHARYNGECTOMY
RESECTION, LATERAL PHARYNGEAL WALL/PYRIFORM SINUS,
RESECTION, PHARYNGEAL WALL REQUIRING CLOSURE W/MYO
SUTURE PHARYNX, WOUND/INJURY
PATIENT SCREENED FOR INJECTION DRUG USE
PT SCRND - HGH-RSK SEXUAL BEHAVIOR
PHARYNGOPLASTY (PLASTIC/RECONSTRUCTIVE OPERATION O
PHARYNGOESOPHAGEAL REPAIR
PHARYNGOSTOMY (FISTULIZATION, PHARYNX, EXT, FEEDIN
CONTROL OROPHARYNGEAL HEMORRHAGE; SIMPLE
CONTROL OROPHARYNGEAL HEMORRHAGE; COMPLICATED, W/H
CONTROL OROPHARYNGEAL HEMORRHAGE; W/SECONDARY SURG
CONTROL NASOPHARYNGEAL HEMORRHAGE; SIMPLE, W/POSTE
CONTROL NASOPHARYNGEAL HEMORRHAGE; COMPLICATED, W/
CONTROL NASOPHARYNGEAL HEMORRHAGE; W/SECONDARY SUR
UNLISTED PROC, PHARYNX/ADENOIDS/TONSILS
PT RCVNG WARFARIN THXPY - NONVALV AFIB OR AFLUT
PT NOT RCVNG WARFARIN THXPY - NONVALV AFIB/AFLUT
ESOPHAGOTOMY, CERVICAL APPROACH, W/REMOVAL, FB
CRICOPHARYNGEAL MYOTOMY
ESOPHAGOTOMY, THORACIC APPROACH, W/ REMOVAL, FB
PT ED RE FT CARE INSPCT RCVD
PT TLK PSYCH & RX OPD ADDIC
EXCISION, LESION, ESOPHAGUS, W/PRIMARY REPAIR; CER
EXCISION, LESION, ESOPHAGUS, W/PRIMARY REPAIR; THO
TOTAL/NEAR TOTAL ESOPHAGECTOMY, W/O THORACOTOMY; W
TOTAL/NEAR TOTAL ESOPHAGECTOMY, W/O THORACOTOMY; W
TOTAL/NEAR TOTAL ESOPHAGECTOMY, W/THORACOTOMY; W/P
TOTAL/NEAR TOTAL ESOPHAGECTOMY, W/THORACOTOMY; W/C
PARTL ESOPHAGECTOMY, CERVICAL W/FREE INTESTINAL GR
PARTL ESOPHAGECTOMY, DISTAL TWO THRDS, W/THORACOTO
PARTL ESOPHAGECTOMY, DISTAL TWO THRDS, W/THORACTMY
PARTL ESOPHAGECTOMY, DISTAL TWO THRDS, W/THORACOTO
PARTL ESOPHAGECTOMY, THORACOABDOMINAL/ABDOMINAL AP
PARTL ESOPHAGECTOMY, THORACOABDOMINAL/ABDOMINAL AP
TOTAL/PARTL ESOPHAGECTOMY, W/O RECONSTRUCTION, W/C
DIVERTICULECTOMY, HYPOPHARYNX/ESOPHAGUS, W/WO MYOT
DIVERTICULECTOMY, HYPOPHARYNX/ESOPHAGUS, W/WO MYOT
ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH
ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH
ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL
ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY
ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY
ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION
ESOPHAGOSCOPY RIG TRANSORAL GUIDE WIRE DILATION
ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC
ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY
ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC
ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ
ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES
ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES
ESOPHAGOSCOPY TRANSORAL W/OPTICAL ENDOMICROSCOPY
PT TALK PSYCHSOC & PHARM TXTMNT OPTS OH DEPEND
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ESOPHAGOGASTRIC FUNDO
ESOPHAGOSCOPY FLEXIBLE TRANSORAL MUCOSAL RESEXN
ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT
ESOPHAGOSCOPY RETROGRADE DILATE BALLOON/OTHER
ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM
ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
ESPHGSC FLEX LESION REMOVAL HOT BX FORCEPS/CAUT
ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE
ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM
ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION
10/1/2008
1/1/2004
1/1/2004
10/1/2008
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
6/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2008
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2008
10/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
10/1/2008
1/1/2016
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
43227
43229
4322F
43231
43232
43233
43235
43236
43237
43238
43239
43240
43241
43242
43243
43244
43245
43246
43247
43248
43249
4324F
43250
43251
43252
43253
43254
43255
43257
43259
4325F
43260
43261
43262
43263
43264
43265
43266
4326F
43270
43273
43274
43275
43276
43277
43278
43279
43280
43281
43282
43283
43289
4328F
43300
43305
4330F
43310
43312
43313
43314
43320
43325
43327
43328
43330
43331
43332
43333
43334
43335
43336
43337
43338
43340
43341
43351
43352
43360
43361
43400
43401
43405
4340F
43410
43415
43420
43425
43450
43453
43460
43496
ESOPHAGOSCOPY FLEXIBLE W BLEEDING CONTROL
ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION
CRGVR PROVIDED W/ ED REFERRED ADDL RESOURCES
ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM
ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX
EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER
ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION
ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS
EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS
EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST
EGD INTRALUMINAL TUBE/CATHETER INSERTION
EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY
EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES
EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES
EGD DILATION GASTRIC/DUODENAL STRICTURE
EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
EGD FLEXIBLE FOREIGN BODY REMOVAL
EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
PT QUERIED PARKINSONS MED-RELATED COMPLICATION
EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
EGD FLEX TRANSORAL W/OPTICAL ENDOMICROSCOPY
EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER
EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION
EGD TRANSORAL CONTROL BLEEDING ANY METHOD
EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD
EGD US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM
MED SURG TXMNT OPTIONS RVWD W/ PT-CAREGIVER
ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY; W/
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY; W/
ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI
ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT
ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD
EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION
PT (OR CAREGIVER) QUERIED RE AUTO DYSFXN SYMTOMS
EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE
ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC
ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT
ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT
ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE
ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA
ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE
LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED
LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY
LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH
LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH
LAPS ESOPHAGEAL LENGTHENING ADDL
UNLISTED PROC, LAPAROSCOPY, ESOPHAGUS
PT (OR CAREGIVER) QUERIED RE SLEEP DISTURBANCES
ESOPHAGOPLASTY, CERVICAL APPROACH; W/O REPAIR, TRA
ESOPHAGOPLASTY, CERVICAL APPROACH; W/REPAIR, TRACH
COUNSELING RE EPIL SPEC SAFETY FOR PT/CRGVR(S)
ESOPHAGOPLASTY, THORACIC APPROACH; W/O REPAIR, TRA
ESOPHAGOPLASTY, THORACIC APPROACH; W/REPAIR, TRACH
ESOPHAGOPLASTY CONGENITAL DEFECT, THORACIC APPROAC
ESOPHAGOPLASTY CONGENITAL DEFECT, THORACIC APPROAC
ESOPHAGOGASTROSTOMY, W/WO VAGOTOMY AND PYLOROPLAST
ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH
ESOPG/GSTR FUNDOPLASTY W/LAPT
ESOPG/GSTR FUNDOPLASTY W/THORCOM
ESOPHAGOMYOTOMY; ABDOMINAL APPROACH
ESOPHAGOMYOTOMY; THORACIC APPROACH
RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH
LAPT RPR PARAESOPH HIATAL HERNIA W/ MESH
RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH
RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH
RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH
RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH
ESOPHAGUS LENGTHENING
ESOPHAGOJEJUNOSTOMY (WITHOUT TOTAL GASTRECTOMY); A
ESOPHAGOJEJUNOSTOMY (WITHOUT TOTAL GASTRECTOMY); T
ESOPHAGOSTOMY, FISTULIZATION, ESOPHAGUS, EXT; THOR
ESOPHAGOSTOMY, FISTULIZATION, ESOPHAGUS, EXT; CERV
GI RECONSTRUCTION, PRIOR ESOPHAGECTOMY; W/STOMACH,
GI RECONSTRUCTION, PRIOR ESOPHAGECTOMY; W/COLON IN
LIGATION, DIRECT, ESOPHAGEAL VARICES
TRANSECTION, ESOPHAGUS W/REPAIR, ESOPHAGEAL VARICE
LIGATION/STAPLING AT GASTROESOPHAGEAL JUNCTION, PR
COUNSELING WOMEN CHILDBEARING WITH EPILEPSY
SUTURE, ESOPHAGEAL WOUND/INJURY; CERVICAL APPROACH
SUTURE, ESOPHAGEAL WOUND/INJURY; TRANSTHORACIC/TRA
CLOSURE, ESOPHAGOSTOMY/FISTULA; CERVICAL APPROACH
CLOSURE, ESOPHAGOSTOMY/FISTULA; TRANSTHORACIC/TRAN
DILATION, ESOPHAGUS, UNGUIDED SOUND/BOUGIE, SINGLE
DILATION, ESOPHAGUS, OVER GUIDE WIRE
ESOPHAGOGASTRIC TAMPONADE, W/BALLOON
FREE JEJUNUM TRANSFER W/MICROVASCULAR ANASTOMOSIS
1/1/2004
1/1/2014
1/1/2012
1/1/2004
1/1/2004
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2010
1/1/2004
1/1/2004
1/1/2013
1/1/2014
1/1/2014
1/1/2004
1/1/2007
1/1/2004
10/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
10/1/2010
1/1/2014
1/1/2009
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2009
1/1/2004
1/1/2010
1/1/2010
1/1/2011
1/1/2004
10/1/2010
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
43499
43500
43501
43502
4350F
43510
43520
43605
43610
43611
43620
43621
43622
43631
43632
43633
43634
43635
43640
43641
43644
43645
43647
43648
43651
43652
43653
43659
43752
43753
43754
43755
43756
43757
43760
43761
43770
43771
43772
43773
43774
43775
43800
43810
43820
43825
43830
43831
43832
43840
43842
43843
43845
43846
43847
43848
43850
43855
43860
43865
43870
43880
43881
43882
43886
43887
43888
43999
44005
4400F
44010
44015
44020
44021
44025
44050
44055
44100
44110
44111
44120
44121
44125
44126
44127
44128
44130
44132
44133
44135
44136
UNLISTED PROC, ESOPHAGUS
GASTROTOMY; W/EXPLORATION/FB REMOVAL
GASTROTOMY; W/SUTURE REPAIR, BLEEDING ULCER
GASTROTOMY; W/SUTURE REPAIR, PRE-EXISTING ESOPHAGO
COUNSELING PROVIDED SYMP MNGMNT PALLIATION
GASTROTOMY; W/ESOPHAGEAL DILATION/INSERTION PERMAN
PYLOROMYOTOMY, CUTTING, PYLORIC MUSCLE
BX STOMACH LAPT
EXCISION, LOCAL; ULCER/BENIGN TUMOR, STOMACH
EXCISION, LOCAL; MALIGNANT TUMOR, STOMACH
GASTRECTOMY, TOTAL; W/ESOPHAGOENTEROSTOMY
GASTRECTOMY, TOTAL; W/ROUX-EN-Y RECONSTRUCTION
GASTRECTOMY, TOTAL; W/FORMATION, INTESTINAL POUCH,
GASTRECTOMY, PARTIAL, DISTAL; W/GASTRODUODENOSTOMY
GASTRECTOMY, PARTIAL, DISTAL; W/GASTROJEJUNOSTOMY
GASTRECTOMY, PARTIAL, DISTAL; W/ROUX-EN-Y RECONSTR
GASTRECTOMY, PARTIAL, DISTAL; W/FORMATION, INTESTI
VAGOTOMY W/PARTIAL DISTAL GASTRECTOMY
VAGOTOMY W/PYLOROPLASTY, W/WO GASTROSTOMY; TRUNCAL
VAGOTOMY W/PYLOROPLASTY, W/WO GASTROSTOMY; PARIETA
LAPAROSCOPY, SURGICAL GASTRIC RESTRICTIVE PROCEDUR
LAPAROSCOPY, SURGICAL GASTRIC RESTRICTIVE PROCEDUR
Lap impl electrode, antrum
Lap revise/remv eltrd antrum
LAPAROSCOPY, SURGICAL; TRANSECTION, VAGUS NERVES,
LAPAROSCOPY, SURGICAL; TRANSECTION, VAGUS NERVES,
LAPAROSCOPY, SURGICAL; GASTROSTOMY, W/O CONSTRUCTI
UNLISTED PROC, LAPAROSCOPY, STOMACH
NASO-/ORO-GASTRIC TUBE PLACEMENT, REQUIRING PHYSIC
GASTRIC TUBE PLMT W/ASPIR & LAVAGE
GASTRIC TUBE DX PLMT W/ASPIR 1 SPECIMEN
GASTRIC TUBE DX PLMT W/ASPIR MULT SPECIMENS
DUODENAL TUBE DX PLMT W/IMG GID 1 SPECIMEN
DUODENAL TUBE DX PLMT W/IMG GID MULT SPECIMEN
CHANGE, GASTROSTOMY TUBE
REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO
LAPAROSCOPY, SURG; GASTRIC RESTRICTIVE PROCEDURE;
Laparoscopy, surgical, gastric restrictive procedu
LAPAROSCOPY, SURG; GASTRIC RESTRICTIVE PROCEDURE;
LAPAROSCOPY, SURG; GASTRIC RESTRICTIVE PROCEDURE;
LAPAROSCOPY, SURG; GASTRIC RESTRICTIVE PROCEDURE;
LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY
PYLOROPLASTY
GASTRODUODENOSTOMY
GASTROJEJUNOSTOMY; W/O VAGOTOMY
GASTROJEJUNOSTOMY; W/VAGOTOMY, ANY TYPE
GASTROSTOMY, OPEN; W/O CONSTRUCTION, GASTRIC TUBE
GASTROSTOMY, OPEN; NEONATAL, FOR FEEDING
GASTROSTOMY, OPEN; W/CONSTRUCTION, GASTRIC TUBE
GASTRORRHAPHY, SUTURE, PERFORATED DUODENAL/GASTRIC
GASTRIC RESTRICTIVE PROC, W/O GASTRIC BYPASS, MORB
GASTRIC RESTRICTVE PROC, W/O GASTRIC BYPASS, MORBI
GASTRIC RESTICTIVE PROCEDURE WITH PART GASTRECTOMY
GASTRIC RESTRICTVE PROCEDRE, W/GASTRIC BYPASS, MOR
GASTRIC RESTRICTIVE PROC, W/GASTRIC BYPASS, MORBID
REVISION, GASTRIC RESTRICTIVE PROC, MORBID OBESITY
REVISION, GASTRODUODENAL ANASTOMOSIS (GASTRODUODEN
REVISION, GASTRODUODENAL ANASTOMOSIS (GASTRODUODEN
REVISION, GASTROJEJUNAL ANASTOMOSIS W/RECONSTRUCTI
REVISION, GASTROJEJUNAL ANASTOMOSIS W/RECONSTRUCTI
CLOSURE, GASTROSTOMY, SURGICAL
CLOSURE, GASTROCOLIC FISTULA
Impl/redo electrd, antrum
Revise/remove electrd antrum
GASTRIC RESTRICTIVE PROCEDURE; OPEN; REVISION OF S
GASTRIC RESTRICTIVE PROCEDURE; OPEN; REMOVAL OF SU
GASTRIC RESTRICT PROCEDURE; OPEN; REM & REPLACEMEN
UNLISTED PROC, STOMACH
ENTEROLYSIS (FREEING, INTESTINAL ADHESION) (SEP PR
REHAB THXPY OPTIONS DISCUSSED W/ PT-CAREGIVER
DUODENOTOMY, EXPLORATION, BX(S)/FB REMOVAL
TUBE/NEEDLE CATHETER JEJUNOSTOMY, ENTERAL ALIMENTA
ENTEROTOMY, SMALL BOWEL, NON-DUODENUM; EXPLORATION
ENTEROTOMY, SMALL BOWEL, NON-DUODENUM; DECOMPRESSI
COLOTOMY, EXPLORATION, BX(S)/FB REMOVAL
REDUCTION, VOLVULUS, INTUSSUSCEPTION, INT HERNIA,
CORRECTION, MALROTATION, LYSIS, DUODENAL BANDS AND
BX, INTESTINE, CAPSULE/TUBE/PERORAL, MORE THAN 1 S
EXCISION, 1 MORE THAN LESION, SMALL/LARGE BOWEL; S
EXCISION, MORE THAN 1 LESION, SMALL/LARGE BOWEL; M
ENTERECTOMY, RESECTION, SMALL INTESTINE; SINGLE RE
ENTERECTOMY, RESECTION, SMALL INTESTINE; ADDL RESE
ENTERECTOMY, RESECTION, SMALL INTESTINE; W/ ENTERO
ENTERECTOMY, RESECT SMALL INTESTINE CONGENITAL ATR
ENTERECTOMY, RESECT SMALL INTESTINE CONGENITAL ATR
ENTERECTOMY, RESECT SMALL INTESTINE CONGENITAL ATR
ENTEROENTEROSTOMY, ANASTOMOSIS, INTESTINE, W/WO CU
DONOR ENTERECTOMY, OPEN, W/PREP AND MAINTENANCE, A
DONOR ENTERECTOMY, OPEN WITH PREP AND MAINTENANCE,
INTESTINAL ALLOTRANSPLANTATION; FROM CADAVER DONOR
INTESTINAL ALLOTRANSPLANTATION; FROM LIVING DONOR
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2010
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
10/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
44137
44139
44140
44141
44143
44144
44145
44146
44147
44150
44151
44155
44156
44157
44158
44160
44180
44186
44187
44188
44202
44203
44204
44205
44206
44207
44208
44210
44211
44212
44213
44227
44238
44300
44310
44312
44314
44316
44320
44322
44340
44345
44346
44360
44361
44363
44364
44365
44366
44369
44370
44372
44373
44376
44377
44378
44379
44380
44381
44382
44384
44385
44386
44388
44389
44390
44391
44392
44394
44401
44402
44403
44404
44405
44406
44407
44408
44500
4450F
44602
44603
44604
44605
44615
44620
44625
44626
44640
44650
44660
44661
REMOVAL OF TRANSPLANTED INTESTINAL ALLOGRAFT, COMP
MOBILIZATION, SPLENIC FLEXURE, W/PARTIAL COLECTOMY
COLECTOMY, PARTIAL; W/ANASTOMOSIS
COLECTOMY, PARTIAL; W/SKIN LEVEL CECOSTOMY/COLOSTO
COLECTOMY, PARTIAL; W/END COLOSTOMY AND CLOSURE, D
COLECTOMY, PARTIAL; W/RESECTION, W/COLOSTOMY/ILEOS
COLECTOMY, PARTIAL; W/COLOPROCTOSTOMY (LOW PELVIC
COLECTOMY, PARTIAL; W/COLOPROCTOSTOMY (LOW PELVIC
COLECTOMY, PARTIAL; ABDOMINAL AND TRANSANAL APPROA
COLECTOMY, TOTAL, ABDOMINAL, W/O PROCTECTOMY; W/IL
COLECTOMY, TOTAL, ABDOMINAL, W/O PROCTECTOMY; W/CO
COLECTOMY, TOTAL, ABDOMINAL, W/PROCTECTOMY; W/ILEO
COLECTOMY, TOTAL, ABDOMINAL, W/PROCTECTOMY; W/CONT
Colectomy w/ileoanal anast
Colectomy w/neo-rectum pouch
COLECTOMY, PARTIAL, W/REMOVAL, TERMINAL ILEUM W/IL
LAPAROSCOPY; ENTEROLYSIS
LAPAROSCOPY, SURGICAL; JEJUNOSTOMY
LAPAROSCOPY; SURGICAL, COLOSTOMY OR SKILL LEVEL CE
Laparoscopy, surgical, colostomy or skin level cec
LAPAROSCOPY, SURGICAL; ENTERECTOMY, INTESTINAL RES
LAPAROSCOPY, SURGICAL; EACH ADDL SMALL INTESTINE R
LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, W/ANAST
LAPAROSCOPY, SURGICAL; COLECTOMY, PARTIAL, W/REMOV
LAP, SURG; COLECTOMY, PARTIAL, W/END COLOSTOMY AND
LAP, SURG; COLECTOMY, PARTIAL, W/ANASTOMOSIS, W/CO
LAP, SURG; COLECTOMY, PARTIAL, W/ANASTOMOSIS, W/CO
LAP, SURG; COLECTOMY, TOTAL, ABDOM, W/O PROCTECTOM
LAP, SURG; COLECTOMY, ABD W/PROCTECTOMY W/ILEOANAL
LAP, SURG; COLECTOMY, TOT, ABDOM, W/PROCTECTOMY, W
LAPAROSCOPY; SURGICAL, MOBILIZATION OF SPLENIC FLE
LAPAROSCOPY; SURGICAL, CLOSURE OF ENTEROSTOMY; LAR
UNLISTED LAPAROSCOPY PROC, INTESTINE (EXCEPT RECTU
ENTEROSTOMY/CECOSTOMY, TUBE (SEP PROC)
ILEOSTOMY/JEJUNOSTOMY, NON-TUBE (SEP PROC)
REVISION, ILEOSTOMY; SIMPLE (RELEASE, SUPERFICIAL
REVISION, ILEOSTOMY; COMPLICATED (RECONSTRUCTION I
CONTINENT ILEOSTOMY (KOCK PROC) (SEP PROC)
COLOSTOMY/SKIN LEVEL CECOSTOMY; (SEP PROC)
COLOSTOMY/SKIN LEVEL CECOSTOMY; W/MULTIPLE BIOPSIE
REVISION, COLOSTOMY; SIMPLE (RELEASE, SUPERFICIAL
REVISION, COLOSTOMY; COMPLICATED (RECONSTRUCTION I
REVISION, COLOSTOMY; W/REPAIR, PARACOLOSTOMY HERNI
ENDOSCOPY UPPER SMALL INTESTINE
SMALL INTESTINAL ENDO/ENTEROSCOPY, BEYOND 2ND PORT
ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY
SMALL INTESTINAL ENDO/ENTEROSCOPY, BEYOND 2ND PORT
SM INTESTINL ENDO/ENTEROSCOPY, BEYOND 2ND PORTN DU
SMALL INTESTINAL ENDO/ENTEROSCOPY, BEYOND 2ND PORT
SMALL INTESTINAL ENDO/ENTEROSCOPY, BEYOND 2ND PORT
SMALL INTESTINAL ENDO/ENTEROSCOPY, BEYOND 2ND PORT
SMALL INTESTINAL ENDO/ENTEROSCOPY, BEYOND 2ND PORT
SMALL INTESTINAL ENDO/ENTEROSCOPY, BEYOND 2ND PORT
SMALL INTESTINAL ENDO/ENTEROSCOPY, BEYOND 2ND PORT
SMALL INTESTINAL ENDO/ENTEROSCOPY, BEYOND 2ND PORT
SMALL INTESTINAL ENDO/ENTEROSCOPY, BEYOND 2ND PORT
SM INTESTIN ENDOSCOPY, ENTEROSCOPY BEYOND 2ND PORT
ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
ILEOSCOPY STOMA W/BALLOON DILATION
ILEOSCOPY, THROUGH STOMA; W/BX, SINGLE/MULTIPLE
ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT
NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX
NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE
COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX
COLONOSCOPY THROUGH STOMA; W/BX, SINGLE/MULTIPLE
COLONOSCOPY STOMA W/RMVL FOREIGN BODY
COLONOSCOPY STOMA CONTROL BLEEDING
COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS
COLONOSCOPY THROUGH STOMA; W/REMOVAL, LESION, SNAR
COLONOSCOPY STOMA ABLATION LESION
COLONOSCOPY STOMA W/ENDOSCOPIC STENT PLCMT
COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL RESCJ
COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION
COLONOSCOPY STOMA W/BALLOON DILATION
COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM
COLONOSCOPY STOMA W/US GID NDL ASPIR/BX
COLONOSCOPY THROUGH STOMA WITH DECOMPRESSION
INTRODUCTION, LONG GI TUBE (SEP PROC)
SELF-CARE EDUCATION PROVIDED TO PATIENT
SUTURE, SMALL INTESTINE; SINGLE PERFORATION
SUTURE, SMALL INTESTINE; MULTIPLE PERFORATIONS
SUTURE, LARGE INTESTINE; W/O COLOSTOMY
SUTURE, LARGE INTESTINE; W/COLOSTOMY
INTESTINAL STRICTUROPLASTY W/WO DILATION
CLOSURE, ENTEROSTOMY, LARGE/SMALL INTESTINE
CLOSURE, ENTEROSTOMY, LARGE/SMALL INTESTINE; W/RES
CLOSURE, ENTEROSTOMY, LARGE/SMALL INTESTINE; W/RES
CLOSURE, INTESTINAL CUTANEOUS FISTULA
CLOSURE, ENTEROENTERIC/ENTEROCOLIC FISTULA
CLOSURE, ENTEROVESICAL FISTULA; W/O INTESTINAL/BLA
CLOSURE, ENTEROVESICAL FISTULA; W/INTESTINE AND/OR
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
44680
44700
44701
44705
4470F
44715
44720
44721
44799
44800
4480F
4481F
44820
44850
44899
44900
44950
44955
44960
44970
44979
45000
45005
4500F
45020
45100
45108
4510F
45110
45111
45112
45113
45114
45116
45119
45120
45121
45123
45126
45130
45135
45136
45150
45160
45171
45172
45190
4525F
4526F
45300
45303
45305
45307
45308
45309
45315
45317
45320
45321
45327
45330
45331
45332
45333
45334
45335
45337
45338
45340
45341
45342
45346
45347
45349
45350
45378
45379
45380
45381
45382
45384
45385
45386
45388
45389
45390
45391
45392
45393
45395
45397
INTESTINAL PLICATION (SEP PROC)
EXCLUSION, SMALL BOWEL, PELVIS, MESH/PROSTHESIS/NA
IINTRAOPERATIVE COLONIC LAVAGE (ADDL PROC)
PREPARE FECAL MICROBIOTA FOR INSTILLATION
IMPLANT CARDIOVERT-DEFIB (ICD) COUNSELING PROV
PREP DONOR , INTESTINE ALLOGRAFT, MESENTERIC ARTER
PREP DONOR , INTESTINE ALLOGRAFT, VENOUS ANASTOMOS
PREP DONOR , INTESTINE ALLOGRAFT, VENOUS ANASTOMOS
UNLISTED PROC, INTESTINE
EXCISION, MECKELS DIVERTICULUM (DIVERTICULECTOMY)/
PT RCVNG ACE/ARB BETA-BLOCKER TX 3 MONS/LONGER
PT RCVNG ACE/ARB AND BETA BLOCKER > 3 MONTHS
EXCISION, LESION, MESENTERY (SEP PROC)
SUTURE, MESENTERY (SEP PROC)
UNLISTED PROC, MECKELS DIVERTICULUM AND MESENTERY
INCISION AND DRAINAGE APPENDICEAL ABSCESS OPEN
APPENDECTOMY;
APPENDECTOMY; INDICATED PURPOSE, W/OTHER PROC (NOT
APPENDECTOMY; RUPTURED APPENDIX W/ABSCESS/GENERALI
LAPAROSCOPY, SURGICAL, APPENDECTOMY
UNLISTED PROC, LAPAROSCOPY, APPENDIX
TRANSRECTAL DRAINAGE, PELVIC ABSCESS
INCISION AND DRAINAGE, SUBMUCOSAL ABSCESS, RECTUM
REFERRED TO OUTPT CARD REHABILITATION PROGRAM
INCISION AND DRAINAGE, DEEP SUPRALEVATOR, PELVIREC
BX, ANORECTAL WALL, ANAL APPROACH
ANORECTAL MYOMECTOMY
PREVIOUS CARDIAC REHAB FOR QUAL CARD EVENT DONE
PROCTECTOMY; COMPLETE, COMBINED ABDOMINOPERINEAL,
PROCTECTOMY; PARTIAL RESECTION, RECTUM, TRANSABDOM
PROCTECTOMY, COMBINED ABDOMINOPERINEAL, PULL-THROU
PROCTECTOMY, PARTIAL, W/RECTAL MUCOSECTOMY, ILEOAN
PROCTECTOMY, PARTIAL, W/ANASTOMOSIS; ABDOMINAL AND
PROCTECTOMY, PARTIAL, W/ANASTOMOSIS; TRANSSACRAL A
PROCTECTOMY, COMBINED ABDOMINOPERINEAL PULL-THROUG
PROCTECTOMY, COMPLETE, (CONG MEGACOLON) ABD/PERINE
PROCTECT, COMPLETE, (CONG MEGACOLON) ABD/PERINEAL
PROCTECTOMY, PARTIAL, W/O ANASTOMOSIS, PERINEAL AP
PELVIC EXENTERATION, W/PROCTECTOMY/PELVIC ORGAN RE
EXCISION, RECTAL PROCIDENTIA, W/ANASTOMOSIS; PERIN
EXCISION, RECTAL PROCIDENTIA, W/ANASTOMOSIS; ABDOM
EXCISION, ILEOANAL RESERVOIR W/ILEOSTOMY
DIVISION, STRICTURE, RECTUM
EXCISION, RECTAL TUMOR, PROCTOTOMY, TRANSSACRAL/TR
EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
EXC RCT TUM INCL MUSCULARIS PROPRIA
DESTRUCTION, RECTAL TUMOR, TRANSANAL APPROACH
NEUROPSYCHIATRIC INTERVENTION ORDERED
NEUROPSYCHIATRIC INTERVENTION RECEIVED
PROCTOSIGMOIDOSCOPY, RIGID; DX, W/WO SPECIMEN(S),
PROCTOSIGMOIDOSCOPY, RIGID; W/DILATION
PROCTOSIGMOIDOSCOPY, RIGID; W/BX, SINGLE/MULTIPLE
PROCTOSIGMOIDOSCOPY, RIGID; W/REMOVAL, FB
PROCTOSIGMOIDOSCOPY, RIGID; W/REMOVAL, SINGLE LESI
PROCTOSIGMOIDOSCOPY, RIGID; W/REMOVAL, SINGLE LESI
PROCTOSIGMOIDOSCOPY, RIGID; W/REMOVAL, MULTIPLE LE
PROCTOSIGMOIDOSCOPY, RIGID; W/CONTROL, BLEEDING
PROCTOSIGMOIDOSCOPY, RIGID; W/ABLATION, LESION, NO
PROCTOSIGMOIDOSCOPY, RIGID; W/DECOMPRESSION, VOLVU
PROCTOSIGMOIDOSCOPY, RIGID; W/TRANSENDOSCOPIC STEN
SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD
SIGMOIDOSCOPY, FLEXIBLE; W/BX, SINGLE/MULTIPLE
SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
SIGMOIDOSCOPY FLX CONTROL BLEEDING
SIGMOIDOSCOPY, FLEXIBLE; W/DIRECTED SUBMUCOSAL INJ
SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE
SIGMOIDOSCOPY, FLEXIBLE; W/REMOVAL, LESION, SNARE
SIGMOIDOSCOPY FLX TNDSC BALO DILAT
SIGMOIDOSCOPY, FLEXIBLE; W/ENDOSCOPIC ULTRASOUND E
SIGMOIDOSCOPY, FLEXIBLE; W/TRANSENDOSCOPIC ULTRASO
SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES
SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT
SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION
SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)
COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD
COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S)
COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD
COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT
COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES
COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT
COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION
COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX
COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL
COLONOSCOPY FLEXIBLE WITH DECOMPRESSION
LAPAROSCOPY; SURGICAL, PROCTECTOMY, COMPLETE; COMB
LAPAROSCOPY; SURGICAL, PROCTECTOMY, COMPLETE; WITH
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2004
1/1/2004
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1/1/2004
1/1/2004
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1/1/2007
1/1/2004
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1/1/2012
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1/1/2012
1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2015
1/1/2006
1/1/2006
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
45398
45399
45400
45402
4540F
4541F
45499
45500
45505
4550F
4551F
45520
4552F
4553F
45540
45541
4554F
45550
4555F
45560
45562
45563
4556F
4557F
4558F
4559F
4560F
4561F
4562F
4563F
45800
45805
45820
45825
45900
45905
45910
45915
45990
45999
46020
46030
46040
46045
46050
46060
46070
46080
46083
46200
46220
46221
46230
46250
46255
46257
46258
46260
46261
46262
46270
46275
46280
46285
46288
46320
46500
46505
46600
46601
46604
46606
46607
46608
46610
46611
46612
46614
46615
46700
46705
46706
46707
46710
46712
46715
46716
46730
46735
46740
46742
COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)
UNLISTED PROCEDURE COLON
LAPAROSCOPY, SURGICAL, PROCTOPEXY
LAPAROSCOPY, SURGICAL, PROCTOPEXY; WITH SIGMOID RE
DISEASE MODIFYING PHARMACOTHERAPY DISCUSSED
TX PSEUDOBULBAR AFFECT SIALORRHEA/ALS SYMP
UNLISTED LAPAROSCOPY PROCEDURE, RECTUM
PROCTOPLASTY; STENOSIS
PROCTOPLASTY; PROLAPSE, MUCOUS MEMBRANE
OPTIONS NONINVASIVE RESP SUPPORT DISCUSSED W/PT
NUTRITIONAL SUPPORT OFFERED
PERIRECTAL INJECTION, SCLEROSING SOLUTION, PROLAPS
PT OFFERED REFERRAL SPEECH LANGUAGE PATHOLOGIST
PT OFFERED ASSISTANCE PLANNING END LIFE ISSUES
PROCTOPEXY, PROLAPSE; ABDOMINAL APPROACH
PROCTOPEXY, PROLAPSE; PERINEAL APPROACH
PT RECEIVED INHALATIONAL ANESTHETIC AGENT
PROCTOPEXY COMBINED W/SIGMOID RESECTION, ABDOMINAL
PT DID NOT RECEIVE INHALATIONAL ANESTHETIC AGENT
REPAIR, RECTOCELE (SEP PROC)
EXPLORATION, REPAIR, AND PRESACRAL DRAINAGE, RECTA
EXPLORATION, REPAIR, AND PRESACRAL DRAINAGE, RECTA
PT SHOWS 3+RISK FACTORS POST-OP NAUSEA+VOMMITING
PT DOES NOTSHOW3+RISK FACTORS POST-OPNAUSEA/VOMM
PT RCEVD 2 PROPHYLACTIC RX AGENTS PRE+INTRA-OP
1BODY TEMP MEAS>=35.5CW/IN30-15 MINSAFTER ANESTH
ANESTH DID NOT INVOLVE GENERAL/NEURAXIAL ANESTH
PATIENT HAS A CORONARY ARTERY STENT
PATIENT DOES NOT HAVE A CORONARY ARTERY STENT
PT RECVD ASPIRIN W/IN 24 HRS PRIOR ANESTH START
CLOSURE, RECTOVESICAL FISTULA
CLOSURE, RECTOVESICAL FISTULA; W/COLOSTOMY
CLOSURE, RECTOURETHRAL FISTULA
CLOSURE, RECTOURETHRAL FISTULA; W/COLOSTOMY
REDUCTION, PROCIDENTIA (SEP PROC) UNDER ANESTHESIA
DILATION, ANAL SPHINCTER (SEP PROC) UNDER ANESTHES
DILATION, RECTAL STRICTURE (SEP PROC) UNDER ANESTH
REMOVAL, FECAL IMPACTION/FB (SEP PROC) UNDER ANEST
ANORECTAL EXAM, SURGICAL; DIAGNOSTIC
UNLISTED PROC, RECTUM
PLACEMENT, SETON
REMOVAL, ANAL SETON, OTHER MARKER
INCISION AND DRAINAGE, ISCHIORECTAL AND/OR PERIREC
INCISION AND DRAINAGE, INTRAMURAL/INTRAMUSCULAR/SU
INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICI
INCISION AND DRAINAGE, ISCHIORECTAL/INTRAMURAL ABS
INCISION, ANAL SEPTUM (INFANT)
SPHINCTEROTOMY, ANAL, DIVISION, SPHINCTER (SEP PRO
INCISION, THROMBOSED HEMORRHOID, EXT
FISSURECTOMY, W/WO SPHINCTEROTOMY
EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS
HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
EXCISION, EXT HEMORRHOID TAGS AND/OR MULTIPLE PAPI
HEMORRHOIDECTOMY XTRNL 2+ COLUMN/GROUP
HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP
HEMORRHOIDECTOMY, INT AND EXT, SIMPLE; W/FISSURECT
HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY
HEMORRHOIDECTOMY INT & XTRNL 2+ COLUMN/GROUP
HRHC CPLX/X10SV W/FISSURECTOMY
HRHC 2+ COL/GRP W/FSTULECTMY INCL FSSRECTMY
SURGICAL TREATMENT, ANAL FISTULA (FISTULECTOMY/FIS
SURGICAL TREATMENT, ANAL FISTULA (FISTULECTOMY/FIS
SURGICAL TREATMENT, ANAL FISTULA (FISTULECTOMY/FIS
SURGICAL TREATMENT, ANAL FISTULA (FISTULECTOMY/FIS
CLOSURE, ANAL FISTULA W/RECTAL ADVANCEMENT FLAP
ENUCLEATION/EXCISION, EXT THROMBOTIC HEMORRHOID
INJECTION, SCLEROSING SOLUTION, HEMORRHOIDS
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT
ANOSCOPY; W/DILATION
ANOSCOPY; W/BX, SINGLE/MULTIPLE
ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX
ANOSCOPY; W/REMOVAL, FB
ANOSCOPY; W/REMOVAL, SINGLE LESION, HOT FORCEPS/CA
ANOSCOPY; W/REMOVAL, SINGLE TUMOR, POLYP/OTHER LES
ANOSCOPY; W/REMOVAL, MULTIPLE LESIONS, HOT FORCEPS
ANOSCOPY; W/CONTROL, BLEEDING
ANOSCOPY; W/ABLATION, LESION, NOT REMOVED BY HOT F
ANOPLASTY, PLASTIC OPERATION, STRICTURE; ADULT
ANOPLASTY, PLASTIC OPERATION, STRICTURE; INFANT
REPAIR OF ANAL FISTULA W/FIBRIN GLUE
RPR ANORECTAL FISTULA W/ PLUG
REPAIR OF ILEOANAL POUCH FISTULA/SINUS; TRANSPERIN
REPAIR OF ILEOANAL POUCH FISTULA/SINUS; COMBINED T
REPAIR, LOW IMPERFORATE ANUS; W/ANOPERINEAL FISTUL
REPAIR, LOW IMPERFORATE ANUS; W/TRANSPOSITION, ANO
REPAIR, HIGH IMPERF ANUS W/O FISTULA; PERINEAL/SAC
REPAIR, HIGH IMPERF ANUS W/O FISTULA; TRANSABDOMIN
REPAIR, HIGH IMPERF ANUS W/RECTO-URETHRAL/VAGINAL
REPAIR, HIGH IMPERF ANUS W/RECTO-URETHRAL/VAGINAL
1/1/2015
1/1/2015
1/1/2006
1/1/2006
1/1/2013
1/1/2013
1/1/2006
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2004
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2013
1/1/2004
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2010
1/1/2010
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
46744
46746
46748
46750
46751
46753
46754
46760
46761
46762
46900
46910
46916
46917
46922
46924
46930
46940
46942
46945
46946
46947
46999
47000
47001
47010
47015
47100
47120
47122
47125
47130
47133
47135
47136
47140
47141
47142
47143
47144
47145
47146
47147
47300
47350
47360
47361
47362
47370
47371
47379
47380
47381
47382
47383
47399
47400
47420
47425
47460
47480
47490
47500
47505
47510
47511
47525
47530
47531
47532
47533
47534
47535
47536
47537
47538
47539
47540
47541
47542
47543
47544
47550
47552
47553
47554
47555
47556
47560
47561
47562
REPAIR, CLOACAL ANOMALY, ANORECTOVAGINOPLASTY AND
REPAIR, CLOACAL ANOMALY, ANORECTOVAGINOPLASTY, URE
REPAR, CLOACAL ANOMLY, ANORECTOVAGINO/URETHROPLSTY
SPHINCTEROPLASTY, ANAL, INCONTINENCE/PROLAPSE; ADU
SPHINCTEROPLASTY, ANAL, INCONTINENCE/PROLAPSE; CHI
GRAFT, RECTAL INCONTINENCE AND/OR PROLAPSE
REMOVAL, THIERSCH WIRE/SUTURE, ANAL CANAL
SPHINCTEROPLASTY, ANAL, INCONTINENCE, ADULT; MUSCL
SPHINCTEROPLASTY, ANAL, INCONTINENCE, ADULT; LEVAT
SPHINCTEROPLASTY, ANAL, INCONTINENCE, ADULT; IMPLA
DESTRUCTION, ANAL LESION(S), SIMPLE; CHEMICAL
DESTRUCTION, ANAL LESION(S), SIMPLE; ELECTRODESICC
DESTRUCTION, ANAL LESION(S), SIMPLE; CRYOSURGERY
DESTRUCTION, ANAL LESION(S), SIMPLE; LASER SURGERY
DESTRUCTION, ANAL LESION(S), SIMPLE; SURGICAL EXCI
DESTRUCTION, ANAL LESION(S), EXTENSIVE
DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY
CURETTAGE/CAUTERY, ANAL FISSURE W/DILATION SPHINCT
CURETTAGE/CAUTERY, ANAL FISSURE W/DILATION SPHINCT
HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP
HRHC NTRNL LIG OTH THAN RBBR BAND 2+ COL/GRP
HEMORRHOIDEPEXY BY STAPLING
UNLISTED PROC, ANUS
BX, LIVER, NEEDLE; PERCUTANEOUS
BX, LIVER, NEEDLE; INDICATED PURPOSE, W/OTHER MAJO
HEPATOTOMY OPEN DRAINAGE ABSCESS/CYST 1/2 STAGES
LAPAROTOMY, W/ASPIRATION AND/OR INJECTION, HEPATIC
BX, LIVER, WEDGE
HEPATECTOMY, RESECTION, LIVER; PARTIAL LOBECTOMY
HEPATECTOMY, RESECTION, LIVER; TRISEGMENTECTOMY
HEPATECTOMY, RESECTION, LIVER; TOTAL LEFT LOBECTOM
HEPATECTOMY, RESECTION, LIVER; TOTAL RIGHT LOBECTO
DONOR HEPATECTOMY, W/PREP ADN MAINTENANCE, ALLOGRA
LIVER ALLOTRANSPLANTATION; ORTHOTOPIC, PARTIAL/WHO
LIVER ALLOTRANSPLANTATION; HETEROTOPIC, PARTIAL/WH
DONOR HEPATECTOMY, W/PREP AND MAINTENANCE, ALLOGRA
DONOR HEPATECTOMY, W/PREP AND MAINTENANCE, ALLOGRA
DONOR HEPATECTOMY, W/PREP AND MAINTENANCE, ALLOGRA
PREP DONOR, WHOLE LIVER GRAFT, WITHOUT TRISEGEMENT
PREP DONOR, WHOLE LIVER GRAFT, WITH TRIGEMENT SPLI
PREP DONOR, WHOLE LIVER GRAFT, WITH LOVE SPLIT INT
PREP DONOR, LIVER GRAFT, VENOUS ANASTOMOSIS
PREP DONOR, LIVER GRAFT, ARTERIAL ANASTOMOSIS, EAC
MARSUPIALIZATION, CYST/ABSCESS, LIVER
MANAGEMENT, LIVER HEMORRHAGE; SIMPLE SUTURE, LIVER
MANAGEMENT, LIVER HEMORRHAGE; COMPLEX SUTURE, LIVE
MANAGEMENT, LIVER HEMORRHAGE; EXPLORATION, HEPATIC
MANAGEMENT, LIVER HEMORRHAGE; RE-EXPLORATION, HEPA
LAPAROSCOPY, SURGICAL, ABLATION MORE THAN 1 LIVER
LAPAROSCOPY, SURGICAL, ABLATION MORE THAN 1 LIVER
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
ABLATION, OPEN, OVER 1 LIVER TUMOR(S); RADIOFREQUE
ABLATION, OPEN, OVER 1 LIVER TUMOR(S); CRYOSURGICA
ABLATION, OPEN, OVER 1 LIVER TUMOR(S), PERCUTANEOU
ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION
UNLISTED PROC, LIVER
HEPATICOTOMY/HEPATICOSTOMY W/EXPLORATION/DRAINAGE/
CHOLEDOCHOTOMY/OSTOMY W/EXPLORE/DRAIN/REMOVAL CALC
CHOLEDOCHOTOMY/OSTOMY W/EXPLORE/DRAIN/REMOVAL CALC
TRANSDUODENAL SPHINCTEROTOMY/SPHINCTEROPLASTY, W/W
CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX
CHOLECSTOST PRQ W/IMG GID
INJECTION PROC, PERCUTANEOUS TRANSHEPATIC CHOLANGI
INJECTION PROC, CHOLANGIOGRAPHY THROUGH EXISTING C
INTRODUCTION, PERCUTANEOUS TRANSHEPATIC CATHETER,
INTRODUCTION, PERCUTANEOUS TRANSHEPATIC STENT, INT
CHANGE, PERCUTANEOUS BILIARY DRAINAGE CATHETER
REVISION AND/OR REINSERTION, TRANSHEPATIC TUBE
INJECTION PROCEDURE FOR CHOLANGIOGRAPHY, PERCUTANEOUS, COMPLETE DIAGNOSTIC P
INJECTION PROCEDURE FOR CHOLANGIOGRAPHY, PERCUTANEOUS, COMPLETE DIAGNOSTIC P
PLACEMENT OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHO
PLACEMENT OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHO
CONVERSION OF EXTERNAL BILIARY DRAINAGE CATHETER TO INTERNAL-EXTERNAL BILIARY DR
EXCHANGE OF BILIARY DRAINAGE CATHETER (EG, EXTERNAL, INTERNAL-EXTERNAL, OR CONVE
REMOVAL OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, REQUIRING FLUOROSCOPIC GU
PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLA
PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS, INCLDNG DIAGNSTC CHOLANGIO
PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS, INCLDNG DIAG CHOLANGIOGRA
PLACEMENT OF ACCESS THROUGH THE BILIARY TREE AND INTO SMALL BOWEL TO ASSIST WIT
BALLOON DILATION OF BILIARY DUCT(S) OR OF AMPULLA (SPHINCTEROPLASTY), PERCUTANEO
ENDOLUMINAL BIOPSY(IES) OF BILIARY TREE, PERCUTANEOUS, ANY METHOD(S) (EG, BRUSH, F
REMOVAL OF CALCULI/DEBRIS FROM BILIARY DUCT(S) AND/OR GALLBLADDER, PERCUTANEOU
BILIARY ENDOSCOPY, INTRAOPERATIVE(CHOLEDOCHOSCOPY)
BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE/OTHER T
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE/OTHER T
BILIARY ENDOSCOPY, PERCUTANEOUS; W/DILATION BILIAR
BILIARY ENDOSCOPY, PERCUTANEOUS; W/DILATION BILIAR
LAPAROSCOPY, SURGICAL; W/GUIDED TRANSHEPATIC CHOLA
LAPAROSCOPY, SURGICAL; W/GUIDED TRANSHEPATIC CHOLA
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
47563
47564
47570
47579
47600
47605
47610
47612
47620
47630
47700
47701
47711
47712
47715
47720
47721
47740
47741
47760
47765
47780
47785
47800
47801
47802
47900
47999
48000
48001
48020
48100
48102
48105
48120
48140
48145
48146
48148
48150
48152
48153
48154
48155
48160
48400
48500
48510
48520
48540
48545
48547
48548
48550
48551
48552
48554
48556
48999
49000
49002
49010
49020
49040
49060
49062
49082
49083
49084
49180
49185
49203
49204
49205
49215
49220
49250
49255
49320
49321
49322
49323
49324
49325
49326
49327
49329
49400
49402
49405
49406
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY W/CHOLANGIO
LAPAROSCOPY,SURGICAL; CHOLECYSTECTOMY W/EXPLORATIO
LAPAROSCOPY, SURGICAL; CHOLECYSTOENTEROSTOMY
UNLISTED PROC, LAPAROSCOPY, BILIARY TRACT
CHOLECYSTECTOMY
CHOLECYSTECTOMY; W/CHOLANGIOGRAPHY
CHOLECYSTECTOMY W/EXPLORATION, COMMON DUCT
CHOLECYSTECTOMY W/EXPLORATION, COMMON DUCT; W/CHOL
CHOLECYSTECTOMY W/EXPLORATION, COMMON DUCT; W/TRAN
BILIARY DUCT STONE EXTRACTION, PERCUTANEOUS, VIA T
EXPLORATION, CONGENITAL ATRESIA, BILE DUCTS, W/O R
PORTOENTEROSTOMY
EXCISION, BILE DUCT TUMOR, W/WO PRIMARY REPAIR, BI
EXCISION, BILE DUCT TUMOR, W/WO PRIMARY REPAIR, BI
EXCISION, CHOLEDOCHAL CYST
CHOLECYSTOENTEROSTOMY; DIRECT
CHOLECYSTOENTEROSTOMY; W/GASTROENTEROSTOMY
CHOLECYSTOENTEROSTOMY; ROUX-EN-Y
CHOLECYSTOENTEROSTOMY; ROUX-EN-Y W/GASTROENTEROSTO
ANASTOMOSIS, EXTRAHEPATIC BILIARY DUCTS AND GI TRA
ANASTOMOSIS, INTRAHEPATIC DUCTS AND GI TRACT
ANASTOMOSIS, ROUX-EN-Y, EXTRAHEPATIC BILIARY DUCTS
ANASTOMOSIS, ROUX-EN-Y, INTRAHEPATIC BILIARY DUCTS
RECONSTRUCTION, PLASTIC, EXTRAHEPATIC BILIARY DUCT
PLACEMENT, CHOLEDOCHAL STENT
U-TUBE HEPATICOENTEROSTOMY
SUTURE, EXTRAHEPATIC BILIARY DUCT, PRE-EXISTING IN
UNLISTED PROC, BILIARY TRACT
PLACEMENT, DRAINS, PERIPANCREATIC, ACUTE PANCREATI
PLACEMENT, DRAINS, PERIPANCREATIC, ACUTE PANCREATI
REMOVAL, PANCREATIC CALCULUS
BX, PANCREAS, OPEN
BX, PANCREAS, PERCUTANEOUS NEEDLE
Resect/debride pancreas
EXCISION, LESION, PANCREAS
PANCREATECTOMY, DISTAL SUBTOTAL, W/WO SPLENECTOMY;
PANCREATECTOMY, DISTAL SUBTOTAL, W/WO SPLENECTOMY;
PANCREATECTOMY, DISTAL, NEAR-TOTAL W/PRESERVATION,
EXCISION, AMPULLA, VATER
PANCREATECTOMY (WHIPPLE); W/PANCREATOJEJUNOSTOMY
PANCREATECTOMY (WHIPPLE); W/O PANCREATOJEJUNOSTOMY
PANCREATECTOMY (PYLORUS SPARING, WHIPPLE); W/PANCR
PANCREATECTOMY (PYLORUS SPARING, WHIPPLE); W/O PAN
PANCREATECTOMY, TOTAL
PANCREATECTOMY, TOTAL/SUBTOTAL W/AUTOLOGOUS TRANSP
INJECTION PROC, INTRAOPERATIVE PANCREATOGRAPHY
MARSUPIALIZATION, CYST, PANCREAS
EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS OPEN
INT ANASTOMOSIS, PANCREATIC CYST TO GI TRACT; DIRE
INT ANASTOMOSIS, PANCREATIC CYST TO GI TRACT; ROUX
PANCREATORRHAPHY, INJURY
DUODENAL EXCLUSION W/GASTROJEJUNOSTOMY, PANCREATIC
Fuse pancreas and bowel
DONOR PANCREATECTOMY, W/PREP AND MAINTENANCE, CADA
PREP DONOR, PANCREAS ALLOGRAFT
PREP DONOR, PANCREAS ALLOGRAFT, VENOUS ANASTOMOSIS
TRANSPLANTATION, PANCREATIC ALLOGRAFT
REMOVAL, TRANSPLANTED PANCREATIC ALLOGRAFT
UNLISTED PROC, PANCREAS
EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY W/WO
REOPENING, RECENT LAPAROTOMY
EXPLORATION, RETROPERITONEAL AREA W/WO BX(S) (SEP
DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN
DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN
DRAINAGE OF RETROPERITONEAL ABSCESS OPEN
DRAINAGE, EXTRAPERITONEAL LYMPHOCELE TO PERITONEAL
ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
PERITONEAL LAVAGE W/WO IMAGING GUIDANCE
BX, ABDOMINAL/RETROPERITONEAL MASS, PERCUTANEOUS N
SCLEROTHERAPY OF A FLUID COLLECTION (EG, LYMPHOCELE, CYST, OR SEROMA), PERCUTANE
EXCISION/DESTRUCTION OPEN ABDOMINAL TUMORS 5 CM
EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM
EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM
EXCISION, PRESACRAL/SACROCOCCYGEAL TUMOR
STAGING CELIOTOMY, HODGKINS DISEASE/LYMPHOMA
UMBILECTOMY, OMPHALECTOMY, EXCISION, UMBILICUS (SE
OMENTECTOMY, EPIPLOECTOMY, RESECTION, OMENTUM (SEP
LAPAROSCOPY, ABDOMEN, PERITONEUM AND OMENTUM, DX,
LAPAROSCOPY, SURGICAL; W/BX (SINGLE/MULTIPLE)
LAPAROSCOPY, SURGICAL; W/CAVITY/CYST ASPIRATION
LAPAROSCOPY, SURGICAL; W/LYMPHOCELE DRAINAGE TO PE
LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER
Lap revision perm ip cath
Lap w/omentopexy add-on
LAPS W/INSERTION NTRSTL DEV W/IMG GID 1+
UNLISTED PROC, LAPAROSCOPY, ABDOMEN, PERITONEUM AN
INJECTION, AIR/CONTRAST INTO PERITONEAL CAVITY (SE
Remove foreign body, adbomen
IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ
IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2016
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2011
1/1/2004
1/1/2004
1/1/2007
1/1/2014
1/1/2014
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
49407
49411
49412
49418
49419
49421
49422
49423
49424
49425
49426
49427
49428
49429
49435
49436
49440
49441
49442
49446
49450
49451
49452
49460
49465
49491
49492
49495
49496
49500
49501
49505
49507
49520
49521
49525
49540
49550
49553
49555
49557
49560
49561
49565
49566
49568
49570
49572
49580
49582
49585
49587
49590
49600
49605
49606
49610
49611
49650
49651
49652
49653
49654
49655
49656
49657
49659
49900
49904
49905
49906
49999
50010
50020
50040
50045
5005F
50060
50065
50070
50075
50080
50081
50100
5010F
50120
50125
50130
50135
5015F
50200
IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL
PLMT NTRSTL DEV PRQ IABDL IPELVC &/ RPER 1/MLT
PLMT INTRSTL DEV OPN W/IMG GID 1+
INSJ INTRAPERITONEAL CATHETER W/IMG GID
INSERTION TUNNEL INTRAPERITONEAL CATH SUBQ PORT
INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN
REMOVAL TUNNELED INTRAPERITONEAL CATHETER
EXCHANGE ABSCESS/CYST DRAINAGE CATHETER, RADIOLOGI
CONTRAST INJECTION, ASSESSMENT, ABSCESS/CYST VIA D
INSERTION, PERITONEAL-VENOUS SHUNT
REVISION, PERITONEAL-VENOUS SHUNT
INJECTION PROC, EVAL, PREVIOUSLY PLACED PERITONEAL
LIGATION, PERITONEAL-VENOUS SHUNT
REMOVAL, PERITONEAL-VENOUS SHUNT
Insert subq exten to ip cath
Embedded ip cath exit-site
INSERT GASTROSTOMY TUBE PERCUTANEOUS UND FLUOROSCO
INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ UND FLUO
INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS
CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ
REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS
REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ UND FLU
REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS
MECH REMVL OBSTRCTVE MATERL GASTROSTOMY, DUODENOS
CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE
REPAIR, INIT INGUINAL HERNIA, PRETERM INFANT (BIRT
REPAIR, INIT INGUINAL HERNIA, PRETERM INFANT (BIRT
REPAIR, INIT INGUINAL HERNIA, FULL/PRETERM INFANT
REPAIR, INIT INGUINAL HERNIA, FULL/PRETERM INFANT
REPAIR, INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO U
REPAIR, INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO U
REPAIR, INITIAL INGUINAL HERNIA, OVER AGE 5; REDUC
REPAIR, INITIAL INGUINAL HERNIA, OVER AGE 5; INCAR
REPAIR, RECURRENT INGUINAL HERNIA, ANY AGE; REDUCI
REPAIR, RECURRENT INGUINAL HERNIA, ANY AGE; INCARC
REPAIR, INGUINAL HERNIA, SLIDING, ANY AGE
REPAIR, LUMBAR HERNIA
REPAIR, INITIAL FEMORAL HERNIA, ANY AGE; REDUCIBLE
REPAIR, INITIAL FEMORAL HERNIA, ANY AGE; INCARCERA
REPAIR, RECURRENT FEMORAL HERNIA; REDUCIBLE
REPAIR, RECURRENT FEMORAL HERNIA; INCARCERATED/STR
REPAIR, INITIAL INCISIONAL/VENTRAL HERNIA; REDUCIB
REPAIR, INITIAL INCISIONAL/VENTRAL HERNIA; INCARCE
REPAIR, RECURRENT INCISIONAL/VENTRAL HERNIA; REDUC
REPAIR, RECURRENT INCISIONAL/VENTRAL HERNIA; INCAR
IMPLANTATION, MESH/PROSTHESIS, INCISIONAL/VENTRAL
REPAIR, EPIGASTRIC HERNIA; REDUCIBLE (SEP PROC)
REPAIR, EPIGASTRIC HERNIA; INCARCERATED/STRANGULAT
REPAIR, UMBILICAL HERNIA, AGE UNDER 5; REDUCIBLE
REPAIR, UMBILICAL HERNIA, AGE UNDER 5; INCARCERATE
REPAIR, UMBILICAL HERNIA, OVER AGE 5; REDUCIBLE
REPAIR, UMBILICAL HERNIA, OVER AGE 5; INCARCERATED
REPAIR, SPIGELIAN HERNIA
REPAIR, SMALL OMPHALOCELE, W/PRIMARY CLOSURE
REPAIR, LARGE OMPHALOCELE/GASTROSCHISIS; W/WO PROS
REPAIR, LARGE OMPHALOCELE/GASTROSCHISIS; W/REMOVAL
REPAIR, OMPHALOCELE; 1ST STAGE
REPAIR, OMPHALOCELE; 2ND STAGE
LAPAROSCOPY, SURGICAL; REPAIR, INGUINAL HERNIA, IN
LAPAROSCOPY, SURGICAL; REPAIR, INGUINAL HERNIA, RE
LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE
LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED
LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE
LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED
LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE
LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED
UNLISTED PROC, LAPAROSCOPY, HERNIOPLASTY/HERNIORRH
SUTURE, SECONDARY, ABDOMINAL WALL, EVISCERATION/DE
OMENTAL FLAP, EXTRA-ABDOMINAL
OMENTAL FLAP, INTRA-ABDOMINAL (ADDL PROC)
FREE OMENTAL FLAP W/MICROVASCULAR ANASTOMOSIS
UNLISTED PROC, ABDOMEN, PERITONEUM AND OMENTUM
RENAL EXPLORATION, NOT NECESSITATING OTHER SPECIFI
DRAINAGE PERIRENAL/RENAL ABSCESS OPEN
NEPHROSTOMY, NEPHROTOMY W/DRAINAGE
NEPHROTOMY, W/EXPLORATION
Pt counsld on exam for moles
NEPHROLITHOTOMY; REMOVAL, CALCULUS
NEPHROLITHOTOMY; SECONDARY SURGICAL OPERATION, CAL
NEPHROLITHOTOMY; COMPLICATED, CONGENITAL KIDNEY AB
NEPHROLITHOTOMY; REMOVAL, LARGE STAGHORN CALCULUS
PERCUTANEOUS NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY;
PERCUTANEOUS NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY;
TRANSECTION/REPOSITIONING, ABERRANT RENAL VESSELS
DILATED MACULAR/FUNDUS XM COMMUNJ TX PHYS/QHP
PYELOTOMY; W/EXPLORATION
PYELOTOMY; W/DRAINAGE, PYELOSTOMY
PYELOTOMY; W/REMOVAL, CALCULUS
PYELOTOMY; COMPLICATED
Doc fx & test/txmnt for op
RENAL BX; PERCUTANEOUS, TROCAR/NEEDLE
1/1/2014
1/1/2010
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
50205
5020F
50220
50225
50230
50234
50236
50240
50250
50280
50290
50300
50320
50323
50325
50327
50328
50329
50340
50360
50365
50370
50380
50382
50384
50385
50386
50387
50389
50390
50391
50392
50393
50394
50395
50396
50398
50400
50405
50430
50431
50432
50433
50434
50435
50500
5050F
50520
50525
50526
50540
50541
50542
50543
50544
50545
50546
50547
50548
50549
50551
50553
50555
50557
50561
50562
50570
50572
50574
50575
50576
50580
50590
50592
50593
50600
50605
50606
5060F
50610
50620
5062F
50630
50650
50660
50684
50686
50688
50690
50693
50694
RENAL BX; SURGICAL EXPOSURE, KIDNEY
TX SUMM RPRT COMMUN PHYS&PT 1 MO COMPLETE
NEPHRECTOMY, W/PARTIAL URETERECTOMY, ANY OPEN APPR
NEPHRECTOMY, W/PARTIAL URETERECTOMY, ANY OPEN APPR
NEPHRECTOMY, W/PARTIAL URETERECTOMY, OPEN, W/RIB R
NEPHRECTOMY, W/TOTAL URETERECTOMY AND BLADDER CUFF
NEPHRECTOMY, W/TOTAL URETERECTOMY AND BLADDER CUFF
NEPHRECTOMY, PARTIAL
OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND
EXCISION/UNROOFING, CYST(S), KIDNEY
EXCISION, PERINEPHRIC CYST
DONOR NEPHRECTOMY; CADAVER DONOR, UNILAT/BILAT W/P
DONOR NEPHRECTOMY, OPEN, LIVING DONOR W/O ALLOGRAF
BACKBENCH STANDARD PREP; CADAVER DONOR RENAL ALLOG
BACKBENCH STANDARD PREP; LIVING DONOR RENAL ALLOGR
BACKBENCH RECONSTRUCTION; VENOUS ANASTOMOSIS
BACKBENCH RECONSTRUCTION; ARTERIAL ANASTOMOSIS, EA
BACKBENCH RECONSTRUCTION; URETERAL ANASTOMOSIS, EA
RECIPIENT NEPHRECTOMY (SEP PROC)
RENAL ALLOTRANSPLANTATION, IMPLANTATION, GRAFT; W/
RENAL ALLOTRANSPLANTATION, IMPLANTATION, GRAFT; W/
REMOVAL, TRANSPLANTED RENAL ALLOGRAFT
RENAL AUTOTRANSPLANTATION, REIMPLANTATION, KIDNEY
REMOVAL AND REPLACEMENT OF INTERNALLY DWELLING URE
REMOVAL OF INTERNALLY DWELLING URETERA STENT
REMOVE & REPLACE INT DWELL URETERAL STENT TRURL
REMOVE INT DWELL URETERAL STENT TRANSURETHRAL
REMOVAL AND REPLACEMENT OF EXTERNALLY ACCESSIBLE T
REMOVAL OF NEPHROSTOMY TUBE, REQUIRING FLUOROSCOPI
ASPIRATION AND/OR INJECTION, RENAL CYST/PELVIS, NE
INSTILLATION OF THERAPEUTIC AGENT INTO RENAL PELVI
INTRODUCTION, INTRACATHETER/CATHETER, RENAL PELVIS
INTRODUCTION URETERAL CATHETER/STENT, THROUGH RENA
INJECTION PROCEDURE, PYELOGRAPHY, THROUGH NEPHROST
INTRODUCTION, GUIDE INTO RENAL PELVIS AND/OR URETE
MANOMETRIC STUDIES THROUGH NEPHROSTOMY/PYELOSTOMY
CHANGE, NEPHROSTOMY/PYELOSTOMY TUBE
PYELOPLASTY, (FOLEY Y-PYELOPLASTY), PLASTIC OPERAT
PYELOPLASTY, (FOLEY Y-PYELOPLASTY), PLASTIC OPERAT
INJECTION PROCEDURE FOR ANTEGRADE NEPHROSTOGRAM AND/OR URETEROGRAM, COMPL
INJECTION PROCEDURE FOR ANTEGRADE NEPHROSTOGRAM AND/OR URETEROGRAM, COMPL
PLACEMENT OF NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHRO
PLACEMENT OF NEPHROURETERAL CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEP
CONVERT NEPHROSTOMY CATHETER TO NEPHROURETERAL CATHETER, PERCUTANEOUS, INCL
EXCHANGE NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTO
NEPHRORRHAPHY, SUTURE, KIDNEY WOUND/INJURY
PLAN 2 MAIN DR. BY 1 MONTH
CLOSURE, NEPHROCUTANEOUS/PYELOCUTANEOUS FISTULA
CLOSURE, NEPHROVISCERAL FISTULA W/VISCERAL REPAIR;
CLOSURE, NEPHROVISCERAL FISTULA W/VISCERAL REPAIR;
SYMPHYSIOTOMY, HORSESHOE KIDNEY W/WO PYELOPLASTY,
LAPAROSCOPY, SURGICAL; ABLATION OF RENAL CYSTS
LAPS ABLTJ RNL MASS LES W/INTRAOP US
LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY
LAPAROSCOPY, SURGICAL; PYELOPLASTY
LAPAROSCOPY, SURGICAL; RADICAL NEPHRECTOMY
LAPAROSCOPY, SURGICAL; NEPHRECTOMY W/PARTIAL URETE
LAPAROSCOPY, SURGICAL; DONOR NEPHRECTOMY, LIVING D
LAPAROSCOPY, SURGICAL; NEPHRECTOMY W/TOTAL URETERE
UNLISTED LAPAROSCOPY PROCEDURE, RENAL
RENAL ENDOSCOPY THROUGH NEPHROSTOMY/PYELOSTOMY
RENAL ENDOSCOPY THROUGH NEPHROSTOMY/PYELOSTOMY; W/
RENAL ENDOSCOPY THROUGH NEPHROSTOMY/PYELOSTOMY; W/
RENAL ENDOSCOPY THROUGH NEPHROSTOMY/PYELOSTOMY; W/
RENAL ENDOSCOPY THROUGH NEPHROSTOMY/PYELOSTOMY; W/
RENAL ENDOSCOPY THROUGH NEPHROSTOMY/PYELOSTOMY; W/
RENAL ENDOSCOPY THROUGH NEPHROTOMY/PYELOTOMY
RENAL ENDOSCOPY THROUGH NEPHROTOMY/PYELOTOMY; W/UR
RENAL ENDOSCOPY THROUGH NEPHROTOMY/PYELOTOMY; W/BX
RENAL ENDOSCOPY THROUGH NEPHROTOMY/PYELOTOMY; W/EN
RENAL ENDOSCOPY THROUGH NEPHROTOMY/PYELOTOMY; W/FU
RENAL ENDOSCOPY THROUGH NEPHROTOMY/PYELOTOMY; W/RE
LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE
ABLATION, ONE OR MORE RENAL TUMORS, PERCUTANEOUS,
ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY
URETEROTOMY W/EXPLORATION/DRAINAGE (SEP PROC)
URETEROTOMY, INSERTION, INDWELLING STENT, ALL TYPE
ENDOLUMINAL BIOPSY OF URETER AND/OR RENAL PELVIS, NON-ENDOSCOPIC, INCLUDING IMA
FNDNGS MAMMO 2PT W/IN 3 DAYS
URETEROLITHOTOMY; UPPER ONE-THIRD, URETER
URETEROLITHOTOMY; MIDDLE ONE-THIRD, URETER
DOC F2FMAMMO FNDNG IN 3 DAYS
URETEROLITHOTOMY; LOWER ONE-THIRD, URETER
URETERECTOMY, W/BLADDER CUFF (SEP PROC)
URETERECTOMY, TOTAL, ECTOPIC URETER, COMBINATION A
INJECTION PROC, URETEROGRAPHY/URETEROPYELOGRAPHY T
MANOMETRIC STUDIES THROUGH URETEROSTOMY/INDWELLING
CHANGE, URETEROSTOMY TUBE
INJECTION PROC, VISUALIZATION, ILEAL CONDUIT AND/O
PLACEMENT OF URETERAL STENT, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRA
PLACEMENT OF URETERAL STENT, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRA
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2005
1/1/2005
1/1/2005
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2008
1/1/2008
1/1/2006
1/1/2006
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2006
1/1/2008
1/1/2004
1/1/2004
1/1/2016
1/1/2008
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2016
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
50695
50700
50705
50706
50715
50722
50725
50727
50728
50740
50750
50760
50770
50780
50782
50783
50785
50800
50810
50815
50820
50825
50830
50840
50845
50860
50900
50920
50930
50940
50945
50947
50948
50949
50951
50953
50955
50957
50961
50970
50972
50974
50976
50980
5100F
51020
51030
51040
51045
51050
51060
51065
51080
51100
51101
51102
51500
51520
51525
51530
51535
51550
51555
51565
51570
51575
51580
51585
51590
51595
51596
51597
51600
51605
51610
51700
51701
51702
51703
51705
51710
51715
51720
51725
51726
51727
51728
51729
51736
51741
51784
PLACEMENT OF URETERAL STENT, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRA
URETEROPLASTY, PLASTIC OPERATION ON URETER
URETERAL EMBOLIZATION OR OCCLUSION, INCLUDING IMAGING GUIDANCE (EG, ULTRASOUN
BALLOON DILATION, URETERAL STRICTURE, INCLUDING IMAGING GUIDANCE (EG, ULTRASOUN
URETEROLYSIS, W/WO REPOSITIONING, URETER, RETROPER
URETEROLYSIS, OVARIAN VEIN SYNDROME
URETEROLYSIS, RETROCAVAL URETER, W/REANASTOMOSIS,
REVISION, URINARY-CUTANEOUS ANASTOMOSIS (ANY TYPE
REVISION, URINARY-CUTANEOUS ANASTOMOSIS (ANY TYPE
URETEROPYELOSTOMY, ANASTOMOSIS, URETER AND RENAL P
URETEROCALYCOSTOMY, ANASTOMOSIS, URETER TO RENAL C
URETEROURETEROSTOMY
TRANSURETEROURETEROSTOMY, ANASTOMOSIS, URETER TO C
URETERONEOCYSTOSTOMY; ANASTOMOSIS, SINGLE URETER T
URETERONEOCYSTOSTOMY; ANASTOMOSIS, DUPLICATED URET
URETERONEOCYSTOSTOMY; W/EXTENSIVE URETERAL TAILORI
URETERONEOCYSTOSTOMY; W/VESICO-PSOAS HITCH/BLADDER
URETEROENTEROSTOMY, DIRECT ANASTOMOSIS, URETER TO
URETEROSIGMOIDOSTOMY, W/CREATION, SIGMOID BLADDER,
URETEROCOLON CONDUIT, W/BOWEL ANASTOMOSIS
URETEROILEAL CONDUIT (ILEAL BLADDER), W/BOWEL ANAS
CONTINENT DIVERSION, W/BOWEL ANASTOMOSIS, ANY SEGM
URINARY UNDIVERSION
REPLACEMENT, ALL/PART, URETER, BOWEL SEGMENT, W/BO
CUTANEOUS APPENDICO-VESICOSTOMY
URETEROSTOMY, TRANSPLANTATION, URETER TO SKIN
URETERORRHAPHY, SUTURE, URETER (SEP PROC)
CLOSURE, URETEROCUTANEOUS FISTULA
CLOSURE, URETEROVISCERAL FISTULA (W/VISCERAL REPAI
DELIGATION, URETER
LAPAROSCOPY, SURGICAL; URETEROLITHOTOMY
LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY W/CYST
LAPAROSCOPY, SURGICAL; URETERONEOCYSTOSTOMY W/O CY
UNLISTED LAPAROSCOPY PROCEDURE, URETER
URETERAL ENDOSCOPY THROUGH URETEROSTOMY
URETERAL ENDOSCOPY THROUGH URETEROSTOMY; W/URETERA
URETERAL ENDOSCOPY THROUGH URETEROSTOMY; W/BX
URETERAL ENDOSCOPY THROUGH URETEROSTOMY; W/FULGURA
URETERAL ENDOSCOPY THROUGH URETEROSTOMY; W/REMOVAL
URETERAL ENDOSCOPY THROUGH URETEROTOMY, W/WO IRRIG
URETERAL ENDOSCOPY THROUGH URETEROTOMY; W/URETERAL
URETERAL ENDOSCOPY THROUGH URETEROTOMY; W/BX
URETERAL ENDOSCOPY THROUGH URETEROTOMY; W/FULGURAT
URETERAL ENDOSCOPY THROUGH URETEROTOMY; W/REMOVAL
RSK FX REF W/N 24 HRS X-RAY
CYSTOTOMY/CYSTOSTOMY; W/FULGURATION AND/OR INSERTI
CYSTOTOMY/CYSTOSTOMY; W/CRYOSURGICAL DESTRUCTION,
CYSTOSTOMY, CYSTOTOMY W/DRAINAGE
CYSTOTOMY, W/INSERTION, URETERAL CATHETER/STENT (S
CYSTOLITHOTOMY, CYSTOTOMY W/REMOVAL, CALCULUS, W/O
TRANSVESICAL URETEROLITHOTOMY
CYSTOTOMY W/STONE BASKET EXTRACTION/ULTRASONIC AND
DRAINAGE, PERIVESICAL/PREVESICAL SPACE ABSCESS
ASPIRATION BLADDER BY NEEDLE
ASPIRATION BLADDER TROCAR/INTRACATHETER
ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
EXCISION, URACHAL CYST/SINUS, W/WO UMBILICAL HERNI
CYSTOTOMY; SIMPLE EXCISION, VESICAL NECK (SEP PROC
CYSTOTOMY; EXCISION, BLADDER DIVERTICULUM, SINGLE/
CYSTOTOMY; EXCISION, BLADDER TUMOR
CYSTOTOMY, EXCISION/INCISION/REPAIR, URETEROCELE
CYSTECTOMY, PARTIAL; SIMPLE
CYSTECTOMY, PARTIAL; COMPLICATED
CYSTECTOMY, PARTIAL; W/REIMPLANTATION, URETER(S) I
CYSTECTOMY, COMPLETE; (SEP PROC)
CYSTECTOMY, COMPLETE; W/BILAT PELVIC LYMPHADENECTO
CYSTECTOMY, COMPLETE, W/URETEROSIGMOIDOSTOMY/URETE
CYSTECTOMY, COMPLETE, W/URETEROSIGMOIDOSTOMY/URETE
CYSTECTOMY, COMPLETE, W/URETEROILEAL CONDUIT/SIGMO
CYSTECTOMY, COMPLETE, W/URETEROILEAL CONDUIT/SIGMO
CYSTECTOMY, COMPLETE, W/CONTINENT DIVERSION, OPEN,
PELVIC EXENTERATION, COMPLETE, VESICAL/PROSTATIC/U
INJECTION PROC, CYSTOGRAPHY/VOIDING URETHROCYSTOGR
INJECTION PROC AND PLACEMENT, CHAIN, CONTRAST AND/
INJECTION PROC, RETROGRADE URETHROCYSTOGRAPHY
BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLA
INSERTION, NON-INDWELLING BLADDER CATHETER
INSERTION, TEMPORARY INDWELLING BLADDER CATHETER;
INSERTION, TEMPORARY INDWELLING BLADDER CATHETER;
CHANGE, CYSTOSTOMY TUBE; SIMPLE
CHANGE, CYSTOSTOMY TUBE; COMPLICATED
ENDOSCOPIC INJECTION, IMPLANT MATL INTO SUBMUCOSAL
BLADDER INSTILLATION, ANTICARCINOGENIC AGENT (W/DE
SIMPLE CYSTOMETROGRAM
BLADDER PRESSURE MEASUREMENT DURING FILLING
COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
COMPLX CYSTOMETRO W/VOID PRESS&URETHRAL PROFILE
SIMPLE UROFLOWMETRY
COMPLEX UROFLOWMETRY
ELECTROMYOGRAPHY STUDIES, ANAL/URETHRAL SPHINCTER,
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1/1/2004
1/1/2016
1/1/2016
1/1/2004
1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
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1/1/2004
1/1/2004
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1/1/2004
1/1/2009
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
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1/1/2004
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1/1/2004
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1/1/2004
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1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
51785
51792
51797
51798
51800
51820
51840
51841
51845
51860
51865
51880
51900
51920
51925
51940
51960
51980
51990
51992
51999
52000
52001
52005
52007
5200F
52010
52204
52214
52224
52234
52235
52240
52250
52260
52265
52270
52275
52276
52277
52281
52282
52283
52285
52287
52290
52300
52301
52305
52310
52315
52317
52318
52320
52325
52327
52330
52332
52334
52341
52342
52343
52344
52345
52346
52351
52352
52353
52354
52355
52356
52400
52402
52441
52442
52450
52500
5250F
52601
52630
52640
52647
52648
52649
52700
53000
53010
53020
53025
53040
53060
NEEDLE ELECTROMYOGRAPHY STUDIES, ANAL AND/OR URETH
STIMULUS EVOKED RESPONSE
VOIDING PRESSURE STUDIES; INTRA-ABDOMINAL VOIDING
MEASUREMENT, POST-VOIDING RESIDUAL URINE AND/OR BL
CYSTOPLASTY/CYSTOURETHROPLASTY, PLASTIC OPERATION,
CYSTOURETHROPLASTY W/UNILAT/BILAT URETERONEOCYSTOS
ANTERIOR VESICOURETHROPEXY/URETHROPEXY; SIMPLE
ANTERIOR VESICOURETHROPEXY/URETHROPEXY; COMPLICATE
ABDOMINO-VAGINAL VESICAL NECK SUSPENSION, W/WO END
CYSTORRHAPHY, SUTURE, BLADDER WOUND, INJURY/RUPTUR
CYSTORRHAPHY, SUTURE, BLADDER WOUND, INJURY/RUPTUR
CLOSURE, CYSTOSTOMY (SEP PROC)
CLOSURE, VESICOVAGINAL FISTULA, ABDOMINAL APPROACH
CLOSURE, VESICOUTERINE FISTULA
CLOSURE, VESICOUTERINE FISTULA; W/HYSTERECTOMY
CLOSURE, BLADDER EXSTROPHY
ENTEROCYSTOPLASTY, W/BOWEL ANASTOMOSIS
CUTANEOUS VESICOSTOMY
LAPAROSCOPY, SURGICAL; URETHRAL SUSPENSION FOR STR
LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS
UNLISTED LAPAROSCOPY PROCEDURE, BLADDER
CYSTOURETHROSCOPY (SEP PROC)
CYSTOURETHROSCOPY W/IRRIGATION AND EVACUATION CLOT
CYSTOURETHROSCOPY, W/URETERAL CATHETERIZATION
CYSTOURETHROSCOPY, W/URETERAL CATHETERIZATION; W/B
CONSID NEURO EVAL APPROP SURG THXPY EPIL 3YRS
CYSTOURETHROSCOPY, W/EJACULATORY DUCT CATHETERIZAT
CYSTOURETHROSCOPY, W/BX
CYSTOURETHROSCOPY, W/FULGURATION TRIGONE/BLADDER N
CYSTOURETHROSCOPY, W/FULGURATION/TREATMENT LESION(
CYSTOURETHROSCOPY, W/FULGURATION AND/OR RESECTION;
CYSTOURETHROSCOPY, W/FULGURATION AND/OR RESECTION;
CYSTOURETHROSCOPY, W/FULGURATION AND/OR RESECTION;
CYSTOURETHROSCOPY, W/RADIOACTIVE SUBSTANCE INSERTI
CYSTOURETHROSCOPY, W/DILATION, BLADDER, INTERSTITI
CYSTOURETHROSCOPY, W/DILATION, BLADDER, INTERSTITI
CYSTOURETHROSCOPY, W/INT URETHROTOMY; FEMALE
CYSTOURETHROSCOPY, W/INT URETHROTOMY; MALE
CYSTOURETHROSCOPY, W/DIRECT VISION INT URETHROTOMY
CYSTOURETHROSCOPY, W/RESECTION, EXT SPHINCTER
CYSTOURETHROSCOPY, W/CALIBRATION AND/OR DILATION,
CYSTOURETHROSCOPY, W/INSERTION, URETHRAL STENT
CYSTOURETHROSCOPY, W/STEROID INJECTION INTO STRICT
CYSTOURETHROSCOPY, TREATMENT, FEMALE URETHRAL SYND
CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER
CYSTOURETHROSCOPY; W/URETERAL MEATOTOMY, UNILAT/BI
CYSTOURETHROSCOPY; W/RESECTION/FULGURATION, ORTHOT
CYSTOURETHROSCOPY; W/RESECTION/FULGURATION, ECTOPI
CYSTOURETHROSCOPY; W/INCISION/RESECTION, ORIFICE,
CYSTOURETHROSCOPY, W/REMOVAL, FB/CALCULUS/URETERAL
CYSTOURETHROSCOPY, W/REMOVAL, FB/CALCULUS/URETERAL
LITHOLAPAXY; SIMPLE/SMALL (LESS THAN 2.5 CM)
LITHOLAPAXY; COMPLICATED/LARGE (LESS THAN 2.5 CM)
CYSTOURETHROSCOPY; W/REMOVAL, URETERAL CALCULUS
CYSTOURETHROSCOPY; W/FRAGMENTATION, URETERAL CALCU
CYSTOURETHROSCOPY; W/SUBURETERIC INJECTION, IMPLAN
CYSTOURETHROSCOPY; W/MANIPULATION, W/O REMOVAL URE
CYSTOURETHROSCOPY, W/INSERTION, INDWELLING URETERA
CYSTOURETHROSCOPY W/INSERTION, URETERAL GUIDE WIRE
CYSTOURETHROSCOPY; W/TREATMENT URETERAL STRICTURE
CYSTOURETHROSCOPY; W/TREATMENT URETEROPELVIC JUNCT
CYSTOURETHROSCOPY; W/TREATMENT INTRA-RENAL STRICTU
CYSTOURETHROSCOPY W/URETEROSCOPY; W/TREATMENT URET
CYSTOURETHROSCOPY W/URETEROSCOPY; W/TREATMENT URET
CYSTOURETHROSCOPY W/URETEROSCOPY; W/TREATMENT INTR
CYSTOURETHROSCOPY W/URETEROSCOPY AND/OR PYELOSCOPY
CYSTOURETHROSCOPY W/URETEROSCOPY AND/OR PYELOSCOPY
CYSTOURETHROSCOPY W/URETEROSCOPY AND/OR PYELOSCOPY
CYSTOURETHROSCOPY W/URETEROSCOPY AND/OR PYELOSCOPY
CYSTOURETHROSCOPY W/URETEROSCOPY AND/OR PYELOSCOPY
CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT
CYSTOURETHROSCOPY W/INCISION/FULGURATION/RESECTION
CYSTOURETERO W/CONGEN REPR
CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE
CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL
TRANSURETHRAL INCISION, PROSTATE
TRANSURETHRAL RESECTION, BLADDER NECK (SEP PROC)
ASTHMA DISCHARGE PLAN PRESENT
TRANSURETHRAL ELECTROSURGICAL RESECTION, PROSTATE,
TRANSURETHRAL RESECTION; REGROWTH, OBSTRUCTIVE TIS
TRANSURETHRAL RESECTION; POSTOPERATIVE BLADDER NEC
NON-CONTACT LASER COAGULATION, PROSTATE, W/CONTROL
CONTACT LASER VAPOR, W/WO TRANSURETHRAL RESECTION
LASER ENUCLEATION PROSTATE W MORCELLATION
TRANSURETHRAL DRAINAGE, PROSTATIC ABSCESS
URETHROTOMY/URETHROSTOMY, EXT (SEP PROC); PENDULOU
URETHROTOMY/URETHROSTOMY, EXT (SEP PROC); PERINEAL
MEATOTOMY, CUTTING, MEATUS (SEP PROC); EXCEPT INFA
MEATOTOMY, CUTTING, MEATUS (SEP PROC); INFANT
DRAINAGE, DEEP PERIURETHRAL ABSCESS
DRAINAGE, SKENES GLAND ABSCESS/CYST
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1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
53080
53085
53200
53210
53215
53220
53230
53235
53240
53250
53260
53265
53270
53275
53400
53405
53410
53415
53420
53425
53430
53431
53440
53442
53444
53445
53446
53447
53448
53449
53450
53460
53500
53502
53505
53510
53515
53520
53600
53601
53605
53620
53621
53660
53661
53665
53850
53852
53855
53860
53899
54000
54001
54015
54050
54055
54056
54057
54060
54065
54100
54105
54110
54111
54112
54115
54120
54125
54130
54135
54150
54160
54161
54162
54163
54164
54200
54205
54220
54230
54231
54235
54240
54250
54300
54304
54308
54312
54316
54318
54322
DRAINAGE, PERINEAL URINARY EXTRAVASATION; UNCOMPLI
DRAINAGE, PERINEAL URINARY EXTRAVASATION; COMPLICA
BX, URETHRA
URETHRECTOMY, TOTAL, W/CYSTOSTOMY; FEMALE
URETHRECTOMY, TOTAL, W/CYSTOSTOMY; MALE
EXCISION/FULGURATION, CARCINOMA, URETHRA
EXCISION, URETHRAL DIVERTICULUM (SEP PROC); FEMALE
EXCISION, URETHRAL DIVERTICULUM (SEP PROC); MALE
MARSUPIALIZATION, URETHRAL DIVERTICULUM, MALE/FEMA
EXCISION, BULBOURETHRAL GLAND
EXCISION/FULGURATION; URETHRAL POLYP(S), DISTAL UR
EXCISION/FULGURATION; URETHRAL CARUNCLE
EXCISION/FULGURATION; SKENES GLANDS
EXCISION/FULGURATION; URETHRAL PROLAPSE
URETHROPLASTY; 1ST STAGE, FISTULA/DIVERTICULUM/STR
URETHROPLASTY; 2ND STAGE (FORMATION, URETHRA), W/U
URETHROPLASTY, 1-STAGE RECONSTRUCTION, MALE ANTERI
URETHROPLASTY, TRANSPUBIC/PERINEAL, 1-STAGE, REPAI
URETHROPLASTY, 2-STAGE, RECONSTR/REPAIR, PROSTATIC
URETHROPLASTY, 2-STAGE, RECONSTR/REPAIR, PROSTATIC
URETHROPLASTY, RECONSTRUCTION, FEMALE URETHRA
URETHROPLASTY, W/TUBULARIZATION POSTERIOR URETHRA
SLING OPERATION, CORRECTION, MALE URINARY INCONTIN
REMOVAL, REVISION OF SLING FOR MALE URINARY INCONT
INSERTION TANDEM CUFF (DUAL)
INSERTION, INFLATABLE URETHRA/BLADDER NECK SPHINCT
REMOVAL, INFLATABLE URETHRAL/BLADDER NECK SPHINCTE
REMOVAL AND REPLACEMENT, INFLATABLE SPHINCTER W/PU
REMOV AND REPLACE INFLATABLE SPHINCTER W/PUMP/RESE
REPAIR, INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
URETHROMEATOPLASTY, W/MUCOSAL ADVANCEMENT
URETHROMEATOPLASTY, W/PARTIAL EXCISION, DISTAL URE
URETHROLYSIS, TRANSVAGINAL, SECONDARY, OPEN, W/CYS
URETHRORRHAPHY, SUTURE, URETHRAL WOUND/INJURY; FEM
URETHRORRHAPHY, SUTURE, URETHRAL WOUND/INJURY; PEN
URETHRORRHAPHY, SUTURE, URETHRAL WOUND/INJURY; PER
URETHRORRHAPHY, SUTURE, URETHRAL WOUND/INJURY; PRO
CLOSURE, URETHROSTOMY/URETHROCUTANEOUS FISTULA, MA
DILATION, URETHRAL STRICTURE, PASSAGE, SOUND/URETH
DILATION, URETHRAL STRICTURE, PASSAGE, SOUND/URETH
DILATION, URETHRAL STRICTURE/VESICAL NECK, MALE, G
DILATION, URETHRAL STRICTURE, PASSAGE, FILIFORM AN
DILATION, URETHRAL STRICTURE, PASSAGE, FILIFORM AN
DILATION, FEMALE URETHRA W/SUPPOSITORY AND/OR INST
DILATION, FEMALE URETHRA W/SUPPOSITORY AND/OR INST
DILATION, FEMALE URETHRA, GENERAL/CONDUCTION (SPIN
TRANSURETHRAL DESTRUCTION, PROSTATE TISSUE; MICROW
TRANSURETHRAL DESTRUCTION, PROSTATE TISSUE; RADIOF
INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT
TRURL RF FEMALE BLADDER NECK STRS URIN INCONT
UNLISTED PROC, URINARY SYSTEM
SLITTING, PREPUCE, DORSAL/LATERAL (SEP PROC); NEWB
SLITTING, PREPUCE, DORSAL/LATERAL (SEP PROC); EXCE
INCISION AND DRAINAGE, PENIS, DEEP
DESTRUCTION, PENILE LESION, SIMPLE; CHEMICAL
DESTRUCTION, PENILE LESION, SIMPLE; ELECTRODESICCA
DESTRUCTION, PENILE LESION, SIMPLE; CRYOSURGERY
DESTRUCTION, PENILE LESION, SIMPLE; LASER SURGERY
DESTRUCTION, PENILE LESION, SIMPLE; SURGICAL EXCIS
DESTRUCTION, PENILE LESION, EXTENSIVE
BX OF PENIS; (SEP PROC)
BX, PENIS; DEEP STRUCTURES
EXCISION, PENILE PLAQUE (PEYRONIE DISEASE);
EXCISION, PENILE PLAQUE (PEYRONIE DISEASE); W/GRAF
EXCISION, PENILE PLAQUE (PEYRONIE DISEASE); W/GRAF
REMOVAL FB, DEEP PENILE TISSUE
AMPUTATION, PENIS; PARTIAL
AMPUTATION, PENIS; COMPLETE
AMPUTATION, PENIS, RADICAL; W/BILAT INGUINOFEMORAL
AMPUTATION, PENIS, RADICAL; W/BILAT PELVIC LYMPHAD
CIRCUMCISION, USING CLAMP/OTHER DEVICE; NEWBORN
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP/D
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP/D
LYSIS/EXCISION, PENILE POSTCIRCUMCISION ADHESIONS
REPAIR, INCOMPLETE CIRCUMCISION
FRENULOTOMY, PENIS
INJECTION PROC, PEYRONIE DISEASE
INJECTION PROC, PEYRONIE DISEASE; W/SURGICAL EXPOS
IRRIGATION, CORPORA CAVERNOSA, PRIAPISM
INJECTION PROC, CORPORA CAVERNOSOGRAPHY
DYNAMIC CAVERNOSOMETRY W/INJECTION VASOACTIVE DRUG
INJECTION, CORPORA CAVERNOSA W/PHARMACOLOGIC AGENT
PENILE PLETHYSMOGRAPHY
NOCTURNAL PENILE TUMESCENCE AND/OR RIGIDITY TEST
PLASTIC OPERATION, PENIS, STRAIGHTENING, CHORDEE,
PLASTIC OPERATION, PENIS, CORRECTION, CHORDEE/1ST
URETHROPLASTY, 2ND STAGE HYPOSPADIAS REPAIR (W/URI
URETHROPLASTY, 2ND STAGE HYPOSPADIAS REPAIR (W/URI
URETHROPLASTY, 2ND STAGE HYPOSPADIAS REPAIR W/FREE
URETHROPLASTY, 3RD STAGE HYPOSPADIAS REPAIR, RELEA
1 STAGE DISTAL HYPOSPADIAS REPAIR; W/SIMPLE MEATAL
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
54324
54326
54328
54332
54336
54340
54344
54348
54352
54360
54380
54385
54390
54400
54401
54405
54406
54408
54410
54411
54415
54416
54417
54420
54430
54435
54437
54438
54440
54450
54500
54505
54512
54520
54522
54530
54535
54550
54560
54600
54620
54640
54650
54660
54670
54680
54690
54692
54699
54700
54800
54830
54840
54860
54861
54865
54900
54901
55000
55040
55041
55060
55100
55110
55120
55150
55175
55180
55200
55250
55300
55400
55450
55500
55520
55530
55535
55540
55550
55559
55600
55605
55650
55680
55700
55705
55706
55720
55725
55801
55810
1 STAGE DISTAL HYPOSPADIAS REPAIR; W/URETHROPLASTY
1 STAGE DISTAL HYPOSPADIAS REPAIR; W/URETHROPLASTY
1 STAGE DISTAL HYPOSPADIAS REPAIR; W/EXTENSIVE DIS
1 STAGE PROXIMAL PENILE/PENOSCROTAL HYPOSPADIAS RE
1 STAGE PERINEAL HYPOSPADIAS REPAIR W/EXTENSIVE DI
REPAIR, HYPOSPADIAS COMPLICATIONS; SIMPLE CLOSURE/
REPAIR, HYPOSPADIAS COMPLICATIONS; W/MOBILIZATION/
REPAIR, HYPOSPADIAS COMPLICATIONS; W/EXTENSIVE DIS
REPAIR, HYPOSPADIAS CRIPPLE W/EXTENSIVE DISSECTION
PLASTIC OPERATION, PENIS TO CORRECT ANGULATION
PLASTIC OPERATION, PENIS, EPISPADIAS, DISTAL TO SP
PLASTIC OPERATION, PENIS, EPISPADIAS, DISTAL TO SP
PLASTIC OPERATION, PENIS, EPISPADIAS, DISTAL TO SP
INSERTION, PENILE PROSTHESIS; NON-INFLATABLE (SEMI
INSERTION, PENILE PROSTHESIS; INFLATABLE (SELF-CON
INSERTION, (MULTI-COMPONENT) INFLATABLE PENILE PRO
REMOVAL, MULTI-COMPONENT INFLATABLE PENILE PROSTHE
REPAIR COMPONENT(S) MULTI-COMPONENT, INFLATABLE PE
REMOVAL AND REPLACEMENT, MULTI-COMPONENT INFLATABL
REMOVAL AND REPLACEMENT, MULTI-COMPONENT INFLATABL
REMOVAL, NON-INFLATABLE (SEMI-RIGID)/INFLATABLE (S
REMOVAL AND REPLACEMENT, NON-INFLATABLE (SEMI-RIGI
REMOVAL AND REPLACE, NON-INFLATABLE/INFLATABLE PEN
CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT (PRIAPISM O
CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT (PRIAPIS
CORPORA CAVERNOSA-GLANS PENIS FISTULIZATION, PRIAP
REPAIR OF TRAUMATIC CORPOREAL TEAR(S)
REPLANTATION, PENIS, COMPLETE AMPUTATION INCLUDING URETHRAL REPAIR
PLASTIC OPERATION, PENIS, INJURY
FORESKIN MANIPULATION W/LYSIS, PREPUTIAL ADHESIONS
BX, TESTIS, NEEDLE (SEP PROC)
BX, TESTIS, INCISIONAL (SEP PROC)
EXCISION, EXTRAPARENCHYMAL LESION, TESTIS
ORCHIECTOMY, SIMPLE, W/WO PROSTHESIS, SCROTAL/INGU
ORCHIECTOMY, PARTIAL
ORCHIECTOMY, RADICAL, TUMOR; INGUINAL APPROACH
ORCHIECTOMY, RADICAL, TUMOR; W/ABDOMINAL EXPLORATI
EXPLORATION, UNDESCENDED TESTIS (INGUINAL/SCROTAL
EXPLORATION, UNDESCENDED TESTIS W/ABDOMINAL EXPLOR
REDUCTION, TORSION, TESTIS, SURGICAL, W/WO FIXATIO
FIXATION, CONTRALATERAL TESTIS (SEP PROC)
ORCHIOPEXY, INGUINAL APPROACH, W/WO HERNIA REPAIR
ORCHIOPEXY, ABDOMINAL APPROACH, FOR INTRA-ABDOMINA
INSERTION, TESTICULAR PROSTHESIS (SEP PROC)
SUTURE/REPAIR, TESTICULAR INJURY
TRANSPLANTATION, TESTIS(ES) TO THIGH (FOR SCROTAL
LAPAROSCOPY, SURGICAL; ORCHIECTOMY
LAPAROSCOPY, SURGICAL; ORCHIOPEXY, INTRA-ABDOMINAL
UNLISTED PROC, LAPAROSCOPY, TESTIS
INCISION AND DRAINAGE, EPIDIDYMIS, TESTIS AND/OR S
BX, EPIDIDYMIS, NEEDLE
EXCISION, LOCAL LESION, EPIDIDYMIS
EXCISION, SPERMATOCELE, W/WO EPIDIDYMECTOMY
EPIDIDYMECTOMY; UNILAT
EPIDIDYMECTOMY; BILAT
Explore epididymis
EPIDIDYMOVASOSTOMY, ANASTOMOSIS, EPIDIDYMIS TO VAS
EPIDIDYMOVASOSTOMY, ANASTOMOSIS, EPIDIDYMIS TO VAS
PUNCTURE ASPIRATION, HYDROCELE, TUNICA VAGINALIS,
EXCISION, HYDROCELE; UNILAT
EXCISION, HYDROCELE; BILAT
REPAIR, TUNICA VAGINALIS HYDROCELE (BOTTLE TYPE)
DRAINAGE, SCROTAL WALL ABSCESS
SCROTAL EXPLORATION
REMOVAL, FB IN SCROTUM
RESECTION, SCROTUM
SCROTOPLASTY; SIMPLE
SCROTOPLASTY; COMPLICATED
VASOTOMY, CANNULIZATION, W/WO INCISION, VAS, UNILA
VASECTOMY, UNILAT/BILAT, W/POSTOPERATIVE SEMEN EXA
VASOTOMY, VASOGRAMS, SEMINAL VESICULOGRAMS/EPIDIDY
VASOVASOSTOMY, VASOVASORRHAPHY
LIGATION (PERCUTANEOUS), VAS DEFERENS, UNILAT/BILA
EXCISION, HYDROCELE, SPERMATIC CORD, UNILAT (SEP P
EXCISION, LESION, SPERMATIC CORD (SEP PROC)
EXCISION, VARICOCELE/LIGATION, SPERMATIC VEINS, VA
EXCISION, VARICOCELE/LIGATION, SPERMATIC VEINS, VA
EXCISION, VARICOCELE/LIGATION, SPERMATIC VEINS, VA
LAPAROSCOPY, SURGICAL; W/LIGATION, SPERMATIC VEINS
UNLISTED PROC, LAPAROSCOPY, SPERMATIC CORD
VESICULOTOMY
VESICULOTOMY; COMPLICATED
VESICULECTOMY, ANY APPROACH
EXCISION, MULLERIAN DUCT CYST
BX, PROSTATE; NEEDLE/PUNCH, SINGLE/MULTIPLE, ANY A
BX, PROSTATE; INCISIONAL, ANY APPROACH
BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID
PROSTATOTOMY, EXT DRAINAGE, PROSTATIC ABSCESS, ANY
PROSTATOTOMY, EXT DRAINAGE, PROSTATIC ABSCESS, ANY
PROSTATECTOMY, PERINEAL, SUBTOTAL
PROSTATECTOMY, PERINEAL RADICAL
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
55812
55815
55821
55831
55840
55842
55845
55860
55862
55865
55866
55870
55873
55875
55876
55899
55920
55970
55980
56405
56420
56440
56441
56442
56501
56515
56605
56606
56620
56625
56630
56631
56632
56633
56634
56637
56640
56700
56740
56800
56805
56810
56820
56821
57000
57010
57020
57022
57023
57061
57065
57100
57105
57106
57107
57109
57110
57111
57112
57120
57130
57135
57150
57155
57156
57160
57170
57180
57200
57210
57220
57230
57240
57250
57260
57265
57267
57268
57270
57280
57282
57283
57284
57285
57287
57288
57289
57291
57292
57295
57296
PROSTATECTOMY, PERINEAL RADICAL; W/LYMPH NODE BX(S
PROSTATECTOMY, PERINEAL RADICAL; W/BILAT PELVIC LY
PROSTATECTOMY; SUPRAPUBIC, SUBTOTAL, 1/2 STAGES
PROSTATECTOMY; RETROPUBIC, SUBTOTAL
PROSTATECTOMY, RETROPUBIC RADICAL, W/WO NERVE SPAR
PROSTATECTOMY, RETROPUBIC RADICAL, W/WO NERVE SPAR
PROSTATECTOMY, RETROPUBIC RADICAL, W/WO NERVE SPAR
EXPOSURE, PROSTATE, ANY APPROACH, RADIATION INSERT
EXPOSURE, PROSTATE, ANY APPROACH, RADIATION INSERT
EXPOSURE, PROSTATE, ANY APPROACH, RADIATION INSERT
LAPS PRSTECT RETROPUBIC RAD W/NRV SPARING ROBOT
ELECTROEJACULATION
ABLATION, CRYOSURGICAL, PROSTATE
Transperi needle place, pros
PLACE INTERSTITIAL DEV RADIATION TX PROSTATE 1+
UNLISTED PROC, MALE GENITAL SYSTEM
PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL
INTERSEX SURGERY; MALE TO FEMALE
INTERSEX SURGERY; FEMALE TO MALE
INCISION AND DRAINAGE, VULVA/PERINEAL ABSCESS
INCISION AND DRAINAGE, BARTHOLINS GLAND ABSCESS
MARSUPIALIZATION, BARTHOLINS GLAND CYST
LYSIS, LABIAL ADHESIONS
Hymenotomy
DESTRUCTION, LESION(S), VULVA; SIMPLE
DESTRUCTION, LESION(S), VULVA; EXTENSIVE
BX, VULVA/PERINEUM (SEP PROC); 1 LESION
BX, VULVA/PERINEUM (SEP PROC); ADDL LESION
VULVECTOMY SIMPLE; PARTIAL
VULVECTOMY SIMPLE; COMPLETE
VULVECTOMY, RADICAL, PARTIAL
VULVECTOMY, RADICAL, PARTIAL; W/UNILAT INGUINOFEMO
VULVECTOMY, RADICAL, PARTIAL; W/BILAT INGUINOFEMOR
VULVECTOMY, RADICAL, COMPLETE
VULVECTOMY, RADICAL, COMPLETE; W/UNILAT INGUINOFEM
VULVECTOMY, RADICAL, COMPLETE; W/BILAT INGUINOFEMO
VULVECTOMY, RADICAL, COMPLETE, W/INGUINOFEMORAL, I
PARTIAL HYMENECTOMY/REVISION, HYMENAL RING
EXCISION, BARTHOLINS GLAND/CYST
PLASTIC REPAIR, INTROITUS
CLITOROPLASTY, INTERSEX STATE
PERINEOPLASTY, REPAIR, PERINEUM, NONOBSTETRICAL (S
COLPOSCOPY, VULVA
COLPOSCOPY, VULVA; W/BIOPSY(S)
COLPOTOMY; W/EXPLORATION
COLPOTOMY; W/DRAINAGE, PELVIC ABSCESS
COLPOCENTESIS (SEP PROC)
INCISION AND DRAINAGE, VAGINAL HEMATOMA; OBSTETRIC
INCISION AND DRAINAGE, VAGINAL HEMATOMA; NON-OBSTE
DESTRUCTION, VAGINAL LESION(S); SIMPLE
DESTRUCTION, VAGINAL LESION(S); EXTENSIVE
BX, VAGINAL MUCOSA; SIMPLE (SEP PROC)
BX, VAGINAL MUCOSA; EXTENSIVE, REQUIRING SUTURE (W
VAGINECTOMY, PARTIAL REMOVAL, VAGINAL WALL;
VAGINECTOMY, PARTIAL REMOVAL, VAGINAL WALL; W/REMO
VAGINECTOMY, PARTIAL REMOVAL, VAGINAL WALL; W/REMO
VAGINECTOMY, COMPLETE REMOVAL, VAGINAL WALL
VAGINECTOMY, COMPLETE REMOVAL, VAGINAL WALL; W/REM
VAGINECTOMY, COMPLETE REMOVAL, WALL; W/REMOVAL, PA
COLPOCLEISIS (LE FORT TYPE)
EXCISION, VAGINAL SEPTUM
EXCISION, VAGINAL CYST/TUMOR
IRRIGATION/TREATMENT, VAGINAL INFECTION
INSJ UTERINE TANDEM&/VAG OVOIDS
INSJ VAGINAL RADIATION DEVICE
FITTING AND INSERTION, PESSARY/OTHER INTRAVAGINAL
DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS
INTRO HEMOSTATIC AGENT/PACK, TREATMENT, VAGINAL BL
COLPORRHAPHY, SUTURE, INJURY, VAGINA (NONOBSTETRIC
COLPOPERINEORRHAPHY, SUTURE, INJURY, VAGINA AND/OR
PLASTIC OPERATION ON URETHRAL SPHINCTER, VAGINAL A
PLASTIC REPAIR, URETHROCELE
ANTERIOR COLPORRHAPHY, REPAIR, CYSTOCELE W/WO REPA
POSTERIOR COLPORRHAPHY, REPAIR, RECTOCELE W/WO PER
COMBINED ANTEROPOSTERIOR COLPORRHAPHY
COMBINED ANTEROPOSTERIOR COLPORRHAPHY; W/ENTEROCEL
INSERTION OF MESH OR OTHER PROSTHESIS FOR REPAIR O
REPAIR, ENTEROCELE, VAGINAL APPROACH (SEP PROC)
REPAIR, ENTEROCELE, ABDOMINAL APPROACH (SEP PROC)
COLPOPEXY, ABDOMINAL APPROACH
SACROSPINOUS LIGAMENT FIXATION, PROLAPSE, VAGINA
COLPOPEXY, VAGINAL, INTRA-PERITNEAL APPROACH
PARAVAGINAL DEFECT REPAIR (W/REPAIR, CYSTOCELE, ST
PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH
REMOVAL/REVISION, SLING, STRESS INCONTINENCE
SLING OPERATION, STRESS INCONTINENCE
PEREYRA PROC, W/ANTERIOR COLPORRHAPHY
CONSTRUCTION, ARTIFICIAL VAGINA; W/O GRAFT
CONSTRUCTION, ARTIFICIAL VAGINA; W/GRAFT
REVISION OF PROSTHETIC VAGINAL GRAFT, VAGINAL APP
Revise vag graft, open abd
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
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1/1/2008
1/1/2004
1/1/2004
1/1/2004
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1/1/2007
1/1/2004
1/1/2004
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1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2007
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
57300
57305
57307
57308
57310
57311
57320
57330
57335
57400
57410
57415
57420
57421
57423
57425
57426
57452
57454
57455
57456
57460
57461
57500
57505
57510
57511
57513
57520
57522
57530
57531
57540
57545
57550
57555
57556
57558
57700
57720
57800
58100
58110
58120
58140
58145
58146
58150
58152
58180
58200
58210
58240
58260
58262
58263
58267
58270
58275
58280
58285
58290
58291
58292
58293
58294
58300
58301
58321
58322
58323
58340
58345
58346
58350
58353
58356
58400
58410
58520
58540
58541
58542
58543
58544
58545
58546
58548
58550
58552
58553
CLOSURE, RECTOVAGINAL FISTULA; VAGINAL/TRANSANAL A
CLOSURE, RECTOVAGINAL FISTULA; ABDOMINAL APPROACH
CLOSURE, RECTOVAGINAL FISTULA; ABDOMINAL APPROACH,
CLOSURE, RECTOVAGINAL FISTULA; TRANSPERINEAL APPRO
CLOSURE, URETHROVAGINAL FISTULA
CLOSURE, URETHROVAGINAL FISTULA; W/BULBOCAVERNOSUS
CLOSURE, VESICOVAGINAL FISTULA; VAGINAL APPROACH
CLOSURE, VESICOVAGINAL FISTULA; TRANSVESICAL AND V
VAGINOPLASTY, INTERSEX STATE
DILATION, VAGINA UNDER ANESTHESIA
PELVIC EXAM UNDER ANESTHESIA
REMOVAL, IMPACTED VAGINAL FB (SEP PROC) UNDER ANES
COLPOSCOPY, ENTIRE VAGINA, W/CERVIX IF PRESENT
COLPOSCOPY, ENTIRE VAGINA, W/CERVIX IF PRESENT; W/
PARAVAGINAL DEFECT REPAIR LAPAROSCOPIC APPROACH
LAPAROSCOPY, SURGICAL, COLPOPEXY
REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC
COLPOSCOPY, CERVIX W/UPPER ADJACENT VAGINA
COLPOSCOPY, CERVIX W/UPPER ADJACENT VAGINA; W/BIOP
COLPOSCOPY, CERVIX W/UPPER ADJACENT VAGINA; W/BIOP
COLPOSCOPY, CERVIX W/UPPER ADJACENT VAGINA; W/ENDO
COLPOSCOPY, CERVIX W/UPPER ADJACENT VAGINA; W/LOOP
COLPOSCOPY, CERVIX W/UPPER ADJACENT VAGINA; W/LOOP
BX/EXCISION, CERVIX LESION W/WO FULGURATION (SEP P
ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILA
CAUTERIZATION, CERVIX; ELECTRO/THERMAL
CAUTERIZATION, CERVIX; CRYOCAUTERY, INITIAL/REPEAT
CAUTERIZATION, CERVIX; LASER ABLATION
CONIZATION, CERVIX W/WO FULGURATION, W/WO D AND C/
CONIZATION, CERVIX W/WO FULGURATION, W/WO D AND C/
TRACHELECTOMY (CERVICECTOMY), AMPUTATION, CERVIX (
TRACHELECTOMY, RADICAL W/BILAT PELVIC LYMPHADENECT
EXCISION, CERVICAL STUMP, ABDOMINAL APPROACH
EXCISION, CERVICAL STUMP, ABDOMINAL APPROACH; W/PE
EXCISION, CERVICAL STUMP, VAGINAL APPROACH
EXCISION, CERVICAL STUMP, VAGINAL APPROACH; W/ANTE
EXCISION, CERVICAL STUMP, VAGINAL APPROACH; W/REPA
D&C of cervical stump
CERCLAGE, UTERINE CERVIX, NONOBSTETRICAL
TRACHELORRHAPHY, PLASTIC REPAIR, UTERINE CERVIX, V
DILATION, CERVICAL CANAL, INSTRUMENTAL (SEP PROC)
ENDOMETRIAL BX W/WO ENDOCERVICAL BX, W/O DILATION,
ENDOMETRIAL SAMPLING PERFORMED IN CONJUNCTION WITH
DILATION AND CURETTAGE, DX AND/OR THERAPEUTIC (NON
MYOMECTOMY 1-4 MYOMA(S), W/TOTAL WEIGHT 250GMS OR
MYOMECTOMY 1-4 MYOMA(S), W/TOTAL WEIGHT 250 GMS OR
MYOMECTOMY 5 OR MORE INTRAMURAL MYOMAS AND/OR TOTA
TOTAL ABDOMINAL HYSTERECTOMY W/WO REMOVAL TUBE(S)/
TOTAL ABDOMINAL HYSTERECTOMY W/WO REMOVAL TUBE(S)/
SUPRACERVICAL ABDOMINAL HYSTERECTOMY, W/WO REMOVAL
TOTAL ABDOMINAL HYSTERECTOMY, W/PARTIAL VAGINECT,
RADICAL ABDOMINAL HYSTERECTOMY W/BILAT PELVIC LYMP
PELVIC EXENTERATION, GYNECOLOGIC MALIGNANCY
VAGINAL HYSTERECTOMY, UTERUS 250 GMS OR LESS
VAGINAL HYSTERECTOMY FOR UTERUS 250 GRAMS OR LESS;
VAGINAL HYSTERECTOMY, UTERUS 250 GMS OR LESS; W/RE
VAGINAL HYSTERECTOMY, UTERUS 250 GMS OR LESS; W/CO
VAGINAL HYSTERECTOMY, UTERUS 250 GMS OR LESS; W/RE
VAGINAL HYSTERECTOMY, W/TOTAL/PARTIAL VAGINECTOMY
VAGINAL HYSTERECTOMY; W/TOTAL/PARTIAL VAGINECTOMY;
VAGINAL HYSTERECTOMY; RADICAL
VAGINAL HYSTERECTOMY, UTERUS GREATER THAN 250 GMS;
VAGINAL HYSTERECTOMY, UTERUS GREATER THAN 250 GMS;
VAGINAL HYSTERECTOMY, UTERUS GREATER THAN 250 GMS;
VAGINAL HYSTERECTOMY, UTERUS GREATER THAN 250 GMS;
VAGINAL HYSTERECTOMY, UTERUS GREATER THAN 250 GMS;
INSERTION, INTRAUTERINE DEVICE
REMOVAL, INTRAUTERINE DEVICE
ARTIFICIAL INSEMINATION; INTRA-CERVICAL
ARTIFICIAL INSEMINATION; INTRA-UTERINE
SPERM WASHING, ARTIFICIAL INSEMINATION
CATHETERIZATION AND INTROD, SALINE INFUSION SONOHY
TRANSCERVICAL INTRODUCTION, FALLOPIAN TUBE CATHETE
INSERTION, HEYMAN CAPSULES, CLINICAL BRACHYTHERAPY
CHROMOTUBATION, OVIDUCT, W/MATLS
ABLATION, ENDOMETRIAL, THERMAL, W/O HYSTEROSCOPIC
ENDOMETRIAL CRYOABLATION WITH ULTRASONIC GUIDANCE,
UTERINE SUSPENSION, W/WO SHORTENING ROUND/SACROUTE
UTERINE SUSPENSION W/WO SHORTENING ROUND/SACROUTER
HYSTERORRHAPHY, REPAIR, RUPTURED UTERUS (NONOBSTET
HYSTEROPLASTY, REPAIR, UTERINE ANOMALY
Lsh, uterus 250 g or less
Lsh w/t/o ut 250 g or less
Lsh uterus above 250 g
Lsh w/t/o uterus above 250 g
LAPAROSCOPY, SURG, MYOMECTOMY; 1-4 INTRAMURAL MYOM
LAPAROSCOPY, SURG, MYOMECTOMY; 5 OR LESS INTRAMURA
Lap radical hyst
LAPAROSCOPY, SURG, W/VAGINAL HYSTERECTOMY, UTERUS
LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; W/REM
LAPAROSCOPY, SURG, W/VAGINAL HYSTERECTOMY, UTERUS
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
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1/1/2010
1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
POS 22 or 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
58554
58555
58558
58559
58560
58561
58562
58563
58565
58570
58571
58572
58573
58578
58579
58600
58605
58611
58615
58660
58661
58662
58670
58671
58672
58673
58679
58700
58720
58740
58750
58752
58760
58770
58800
58805
58820
58822
58825
58900
58920
58925
58940
58943
58950
58951
58952
58953
58954
58956
58957
58958
58960
58970
58974
58976
58999
59000
59001
59012
59015
59020
59025
59030
59050
59051
59070
59072
59074
59076
59100
59120
59121
59130
59135
59136
59140
59150
59151
59160
59200
59300
59320
59325
59350
59400
59409
59410
59412
59414
59425
LAPAROSCOPY, SURG, W/VAGINAL HYSTERECTOMY, FOR UTE
HYSTEROSCOPY, DX (SEP PROC)
HYSTEROSCOPY, SURGICAL; W/ENDOMETRIAL BX AND/OR PO
HYSTEROSCOPY, SURGICAL; W/LYSIS INTRAUTERINE ADHES
HYSTEROSCOPY, SURGICAL; W/DIVISION/RESECTION INTRA
HYSTEROSCOPY, SURGICAL; W/REMOVAL LEIOMYOMATA
HYSTEROSCOPY, SURGICAL, W/REMOVAL IMPACTED FB
HYSTEROSCOPY, SURGICAL; W/ENDOMETRIAL ABLATION
HYSTEROSCOPY, ABLATION
LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 G/<
LAPS TOTAL HYSTERECTOMY 250 G/< W TUBE/OVARY
LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS > 250 G
LAPAROSCOPY TOT HYSTERECTOMY > 250 G W TUBE/OVAR
UNLISTED PROC, LAPAROSCOPY, UTERUS
UNLISTED PROC, HYSTEROSCOPY, UTERUS
LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDO
LIGATION/TRANSECTION, FALLOPIAN TUBE, ABD/VAGINAL
LIGATION/TRANSECTION, FALLOPIAN TUBE W/C-SECTION/S
OCCLUSION OF FALLOPIAN TUBE(S) BY DEVICE (EG, BAND
LAPAROSCOPY, SURGICAL; W/LYSIS, ADHESIONS (SALPING
LAPAROSCOPY, SURGICAL; W/REMOVAL, ADNEXAL STRUCTUR
LAPAROSCOPY, SURGICAL; W/FULGURATION/EXCISION, LES
LAPAROSCOPY, SURGICAL; W/FULGURATION OF OVIDUCTS W
LAPAROSCOPY, SURGICAL; W/OCCLUSION, OVIDUCTS BY DE
LAPAROSCOPY, SURGICAL; W/FIMBRIOPLASTY
LAPAROSCOPY, SURGICAL; W/SALPINOSTOMY
UNLISTED PROC, LAPAROSCOPY, OVIDUCT/OVARY
SALPINGECTOMY, COMPLETE/PARTIAL, UNILAT/BILAT (SEP
SALPINGO-OOPHORECTOMY, COMPLETE/PARTIAL, UNILAT/BI
LYSIS, ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS)
TUBOTUBAL ANASTOMOSIS
TUBOUTERINE IMPLANTATION
FIMBRIOPLASTY
SALPINGOSTOMY (SALPINGONEOSTOMY)
DRAINAGE, OVARIAN CYST(S), UNILAT/BILAT, (SEP PROC
DRAINAGE, OVARIAN CYST(S), UNILAT/BILAT, (SEP PROC
DRAINAGE, OVARIAN ABSCESS; VAGINAL APPROACH, OPEN
DRAINAGE, OVARIAN ABSCESS; ABDOMINAL APPROACH
TRANSPOSITION, OVARY(S)
BX, OVARY, UNILAT/BILAT (SEP PROC)
WEDGE RESECTION/BISECTION, OVARY, UNILAT/BILAT
OVARIAN CYSTECTOMY, UNILAT/BILAT
OOPHORECTOMY, PARTIAL/TOTAL, UNILAT/BILAT
OOPHORECTOMY, PARTIAL/TOTAL, OVARIAN/TUBAL/PRIMARY
RESECTION, OVARIAN/TUBAL/PRIMARY MALIGNANCY W/BSO
RESECTION, OVARIAN/TUBAL/PRIMARY MALIGNANCY W/BSO
RESECTION, OVARIAN/TUBAL/PRIMARY MALIGNANCY W/BSO
BILAT SALPINGO-OOPHORECT W/OMENTECT, TOTAL ABDOM H
BILAT SALPING-OOPHOREC W/OMENTEC, TL ABD HYST AND
BILATERAL SALPINGO-OOPHORESCTOMY WITH TOTAL OMENTE
Resect recurrent gyn mal
Resect recur gyn mal w/lym
LAPAROTOMY, STAGING/RESTAGING, OVARIAN/TUBAL/PRIMA
FOLLICLE PUNCTURE, OOCYTE RETRIEVAL, ANY METHOD
EMBRYO TRANSFER, INTRAUTERINE
GAMETE, ZYGOTE/EMBRYO INTRAFALLOPIAN TRANSFER, ANY
UNLISTED PROC, FEMALE GENITAL SYSTEM (NONOBSTETRIC
AMNIOCENTESIS; DIAGNOSTIC
AMNIOCENTESIS; THERAPEUTIC AMNIOTIC FLUID REDUCTIO
CORDOCENTESIS (INTRAUTERINE), ANY METHOD
CHORIONIC VILLUS SAMPLING, ANY METHOD
FETAL CONTRACTION STRESS TEST
FETAL NON-STRESS TEST
FETAL SCALP BLOOD SAMPLING
FETAL MONITORING IN LABOR, PHYSICIAN W/WRITTEN REP
FETAL MONITORING IN LABOR, PHYSICIAN W/WRITTEN REP
TRANSABDOMINAL AMNIOINFUSION, W/US GUIDANCE
FETAL UMBILICAL CORD OCCLUSION, W/US GUIDANCE
FETAL FLUID DRAINAGE, W/US GUIDANCE
FETAL SHUNT PLACEMENT, W/US GUIDANCE
HYSTEROTOMY, ABDOMINAL
SURGICAL TREATMENT, ECTOPIC PREGNANCY; TUBAL/OVARI
SURGICAL TREATMENT, ECTOPIC PREGNANCY; TUBAL/OVARI
SURGICAL TREATMENT, ECTOPIC PREGNANCY; ABDOMINAL P
SURGICAL TREATMENT, ECTOPIC PREGNANCY; INTERSTITIA
SURGICAL TREATMENT, ECTOPIC PREGNANCY; INTERSTITIA
SURGICAL TREATMENT, ECTOPIC PREGNANCY; CERVICAL, W
LAPAROSCOPIC TREATMENT, ECTOPIC PREGNANCY; W/O SAL
LAPAROSCOPIC TREATMENT, ECTOPIC PREGNANCY; W/SALPI
CURETTAGE, POSTPARTUM
INSERTION, CERVICAL DILATOR (SEP PROC)
EPISIOTOMY/VAG RPR OTH/THN ATTENDING
CERCLAGE, CERVIX, DURING PREGNANCY; VAGINAL
CERCLAGE, CERVIX, DURING PREGNANCY; ABDOMINAL
HYSTERORRHAPHY, RUPTURED UTERUS
ROUTINE OBSTETRIC CARE, ANTEPARTUM CARE, VAGINAL D
VAGINAL DELIVERY ONLY (W/WO EPISIOTOMY AND/OR FORC
VAGINAL DELIVERY ONLY (W/WO EPISIOTOMY AND/OR FORC
EXT CEPHALIC VERSION, W/WO TOCOLYSIS
DELIVERY, PLACENTA (SEP PROC)
ANTEPARTUM CARE ONLY; 4 TO 6 VISITS
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
59426
59430
59510
59514
59515
59525
59610
59612
59614
59618
59620
59622
59812
59820
59821
59830
59840
59841
59850
59851
59852
59855
59856
59857
59866
59870
59871
59897
59898
59899
60000
6005F
60100
60200
60210
60212
60220
60225
60240
60252
60254
60260
60270
60271
60280
60281
60300
6030F
6040F
6045F
60500
60502
60505
60512
60520
60521
60522
60540
60545
60600
60605
60650
60659
60699
6070F
6080F
6090F
61000
61001
6100F
6101F
61020
61026
6102F
61050
61055
61070
61105
61107
61108
6110F
61120
61140
61150
61151
61154
61156
61210
61215
61250
61253
ANTEPARTUM CARE ONLY; 7 (PLUS) VISITS
POSTPARTUM CARE ONLY (SEP PROC)
ROUTINE OBSTETRIC CARE W/ANTEPARTUM CARE, CESAREAN
CESAREAN DELIVERY ONLY
CESAREAN DELIVERY ONLY; W/POSTPARTUM CARE
SUBTOTAL/TOTAL HYSTERECTOMY AFTER CESAREAN DELIVER
ROUTINE OBSTETRIC CARE, VAGINAL DELIVERY, W/ANTEPA
VAGINAL DELIVERY ONLY, PREVIOUS CESAREAN DELIVERY
VAGINAL DELIVERY ONLY, PREVIOUS CESAREAN DELIVERY;
ROUTINE OB CARE, ANTE/POSTPARTUM, CESAREAN DELIVER
CESAREAN DELIVERY, AFTER FAILED VAGINAL DELIVERY,
CESAREAN DELIVERY, AFTER FAILED VAGINAL DELIVERY,
TREATMENT, INCOMPLETE ABORTION, ANY TRIMESTER, COM
TREATMENT, MISSED ABORTION, COMPLETED SURGICALLY;
TREATMENT, MISSED ABORTION, COMPLETED SURGICALLY;
TREATMENT, SEPTIC ABORTION, COMPLETED SURGICALLY
INDUCED ABORTION, DILATION AND CURETTAGE
INDUCED ABORTION, DILATION AND EVACUATION
INDUCED ABORTION, INTRA-AMNIOTIC INJECTIONS W/HOSP
INDUCED ABORTION, INTRA-AMNIOTIC INJECTIONS W/HOSP
INDUCED ABORTION, INTRA-AMNIOTIC INJECTIONS W/HOSP
INDUCED ABORTION, VAGINAL SUPPOSITORIES W/HOSPITAL
INDUCED ABORTION, VAGINAL SUPPOSITORIES W/HOSPITAL
INDUCED ABORTION, VAGINAL SUPPOSITORIES W/HOSPITAL
MULTIFETAL PREGNANCY REDUCTION(S)
UTERINE EVACUATION AND CURETTAGE, HYDATIDIFORM MO
REMOVAL, CERCLAGE SUTURE UNDER ANESTHESIA (OTHER T
UNLISTED FETAL INVASIVE PROCEDURE, W/US GUIDANCE
UNLISTED PROC, LAPAROSCOPY, MATERNITY CARE AND DEL
UNLISTED PROC, MATERNITY CARE AND DELIVERY
INCISION AND DRAINAGE, THYROGLOSSAL CYST, INFECTED
Care level rationale doc
BX THYROID, PERCUTANEOUS CORE NEEDLE
EXCISION, CYST/ADENOMA, THYROID/TRANSECTION, ISTHM
PARTIAL THYROID LOBECTOMY, UNILAT; W/WO ISTHMUSECT
PARTIAL THYROID LOBECTOMY, UNILAT; W/CONTRALATERAL
TOTAL THYROID LOBECTOMY, UNILAT; W/WO ISTHMUSECTOM
TOTAL THYROID LOBECTOMY, UNILAT; W/CONTRALATERAL S
THYROIDECTOMY, TOTAL/COMPLETE
THYROIDECTOMY, TOTAL/SUBTOTAL, MALIGNANCY; W/LIMIT
THYROIDECTOMY, TOTAL/SUBTOTAL, MALIGNANCY; W/RADIC
THYROIDECTOMY, REMOVAL REMAINING TISSUE, FOLLOWING
THYROIDECTOMY, W/SUBSTERNAL THYROID; STERNAL SPLIT
THYROIDECTOMY, W/SUBSTERNAL THYROID; CERVICAL APPR
EXCISION, THYROGLOSSAL DUCT CYST/SINUS
EXCISION, THYROGLOSSAL DUCT CYST/SINUS; RECURRENT
ASPIRATION AND/OR INJECTION THYROID CYST
MAX STERILE BARRIERS FOLLWD
APPRO RAD DS DVCS TECHS DOCD
RADXPS IN END RPRT4FLURO PXD
PARATHYROIDECTOMY/EXPLORATION, PARATHYROID(S)
PARATHYROIDECTOMY/EXPLORATION, PARATHYROID(S); REPARATHYROIDECTOMY/EXPLORATION, PARATHYROID(S); W/M
PARATHYROID AUTOTRANSPLANTATION
THYMECTOMY, PART/TOTAL; TRANSCERVICAL APPROACH (SE
THYMECTOMY, PART/TOTAL; STERNAL SPLIT/TRANSTHORACI
THYMECTOMY, PART/TOTAL; STERNAL SPLIT/TRANSTHORACI
ADRENALECTOMY/EXPLORATION, ADRENAL GLAND, W/WO BX
ADRENALECTOMY/EXPLORATION, ADRENAL GLAND, W/WO BX
EXCISION, CAROTID BODY TUMOR; W/O EXCISION, CAROTI
EXCISION, CAROTID BODY TUMOR; W/EXCISION, CAROTID
LAPAROSCOPY, SURGICAL, W/TRANSABD PARTL/COMPLETE A
UNLISTED PROC, LAPAROSCOPY, SURGICAL, ENDOCRINE SY
UNLISTED PROC, ENDOCRINE SYSTEM
PATIENT QUERIED COUNSELED RE AED SIDE EFFECTS
PATIENT QUERIED ABOUT FALLS
PT-CAREGIVER COUNSELED RE SAFETY ISSUES
SUBDURAL TAP THROUGH FONTANELLE/SUTURE, INFANT, UN
SUBDURAL TAP THROUGH FONTANELLE/SUTURE, INFANT, UN
VERIFY CORRECT PT SITE PXD DOCUMENTED
SAFTETY COUNSELING FOR DEMENTIA PROVIDED (DEM)
VENTRICULAR PUNCTURE, PREVIOUS BURR HOLE; W/O INJE
VENTRICULAR PUNCTURE, PREVIOUS BURR HOLE; W/INJECT
SAFETY COUNSELING FOR DEMENTIA ORDERED (DEM)
CISTERNAL/LATERAL (C1-C2) CERVICAL PUNCTURE; W/O I
CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION
PUNCTURE, SHUNT TUBING/RESERVOIR, ASPIRATION/INJEC
TWIST DRILL HOLE, SUBDURAL/VENTRICULAR PUNCTURE
TWIST DRILL HOLE, SUBDURAL/VENTRICULAR PUNCTURE; I
TWIST DRILL HOLE, SUBDURAL/VENTRICULAR PUNCTURE; E
COUNSELING PROVIDED REGARDING RISKS OF DRIVING
BURR HOLE(S), VENTRICULAR PUNCTURE W/INJECTION
BURR HOLE(S)/TREPHINE; W/BX, BRAIN/INTRACRANIAL LE
BURR HOLE(S)/TREPHINE; W/DRAINAGE, BRAIN ABSCESS/C
BURR HOLE(S)/TREPHINE; W/SUBSEQUENT TAPPING (ASPIR
BURR HOLE(S) W/EVACUATION AND/OR DRAINAGE, HEMATOM
BURR HOLE(S); W/ASPIRATION, HEMATOMA/CYST, INTRACE
BURR HOLE(S); IMPLANTING VENTRICULAR CATHETER/RESE
INSERTION, SUBQ RESERVOIR/PUMP/INFUSION SYSTEM, VE
BUR HOLE(S)/TREPHINE, SUPRATENTORIAL, EXPLORATORY,
BUR HOLE(S)/TREPHINE, INFRATENTORIAL, UNILAT/BILAT
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
4/1/2013
10/1/2010
1/1/2004
1/1/2004
7/1/2011
1/1/2012
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
61304
61305
61312
61313
61314
61315
61316
61320
61321
61322
61323
61330
61332
61333
61340
61343
61345
61450
61458
61460
61480
61500
61501
6150F
61510
61512
61514
61516
61517
61518
61519
61520
61521
61522
61524
61526
61530
61531
61533
61534
61535
61536
61537
61538
61539
61540
61541
61543
61544
61545
61546
61548
61550
61552
61556
61557
61558
61559
61563
61564
61566
61567
61570
61571
61575
61576
61580
61581
61582
61583
61584
61585
61586
61590
61591
61592
61595
61596
61597
61598
61600
61601
61605
61606
61607
61608
61610
61611
61612
61613
61615
CRANIECTOMY/CRANIOTOMY, EXPLORATORY; SUPRATENTORIA
CRANIECTOMY/CRANIOTOMY, EXPLORATORY; INFRATENTORIA
CRANIECTOMY/CRANIOTOMY, EVACUATION, HEMATOMA, SUPR
CRANIECTOMY/CRANIOTOMY, EVACUATION, HEMATOMA, SUPR
CRANIECTOMY/CRANIOTOMY, EVACUATION, HEMATOMA, INFR
CRANIECTOMY/CRANIOTOMY, EVACUATION, HEMATOMA, INFR
INCISION AND SUBQ PLACEMENT, CRANIAL BONE GRAFT
CRANIECTOMY/CRANIOTOMY, DRAINAGE, INTRACRANIAL ABS
CRANIECTOMY/CRANIOTOMY, DRAINAGE, INTRACRANIAL ABS
CRANIECTOMY/CRANIOTOMY, DECOMPRES, W/DURAPLASTY, W
CRANIECTOMY/CRANIOTOMY, DECOMPRES, W/WO DURAPLASTY
DECOMPRESSION, ORBIT ONLY, TRANSCRANIAL APPROACH
EXPLORATION, ORBIT (TRANSCRANIAL APPROACH); W/BX
EXPLORATION, ORBIT (TRANSCRANIAL APPROACH); W/REMO
SUBTEMPORAL CRANIAL DECOMPRESSION (PSEUDOTUMOR CER
CRANIECTOMY, SUBOCCIPITAL W/CERVICAL LAMINECTOMY,
OTHER CRANIAL DECOMPRESSION, POSTERIOR FOSSA
CRANIECTOMY, SUBTEMPORAL, SECTION/COMPRESSION/DECO
CRANIECTOMY, SUBOCCIPITAL; EXPLORATION/DECOMPRESSI
CRANIECTOMY, SUBOCCIPITAL; SECTION, OVER 1 CRANIAL
CRANIECTOMY, SUBOCCIPITAL; MESENCEPHALIC TRACTOTOM
CRANIECTOMY; W/EXCISION, TUMOR/OTHER BONE LESION,
CRANIECTOMY; OSTEOMYELITIS
PT NOT RCVNG 1ST COURSE OF ANTI-TNF THERAPY
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; E
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; E
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; E
CRANIECTOMY, TREPHINATION, BONE FLAP CRANIOTOMY; E
IMPLANTATION, BRAIN INTRACAVITARY CHEMOTHERAPY AGE
CRANIECTOMY, EXCISION TUMOR, INFRATENTORIAL/POSTER
CRANIECTOMY, EXCISION TUMOR, INFRATENTORIAL/POSTER
CRANIECTOMY, EXCISION TUMOR, INFRATENTORIAL/POSTER
CRANIECTOMY, EXCISION TUMOR, INFRATENTORIAL/POSTER
CRANIECTOMY, INFRATENTORIAL/POSTERIOR FOSSA; EXCIS
CRANIECTOMY, INFRATENTORIAL/POSTERIOR FOSSA; EXCIS
CRANIECTOMY, CEREBELLOPONTINE ANGLE TUMOR
CRANIECTOMY, CEREBELLOPONTINE ANGLE TUMOR; MIDDLE/
SUBDURAL IMPLANTATION, STRIP ELECTRODES, LONG TERM
CRANIOTOMY W/ELEVATION, BONE FLAP; IMPLANTATION, E
CRANIOTOMY W/ELEVATION, BONE FLAP; EXCISION, EPILE
CRANIOTOMY W/ELEVATION, BONE FLAP;REMOVAL, EPIDUR/
CRANIOTOMY W/ELEVATION, BONE FLAP; EXCISION, CEREB
CRANIOTOMY W/ELEVATION, BONE FLAP; LOBECTOMY, TEMP
CRANIOTOMY W/ELEVATION, BONE FLAP; LOBECTOMY, TEMP
CRANIOTOMY W/ELEVATION, BONE FLAP; LOBECTOMY EXCEP
CRANIOTOMY W/ELEVATION, BONE FLAP; LOBECTOMY EXCEP
CRANIOTOMY W/ELEVATION, BONE FLAP; TRANSECTION, CO
CRANIOTOMY W/ELEVATION, BONE FLAP; PARTIAL/SUBTOTA
CRANIOTOMY W/ELEVATION, BONE FLAP; EXCISION/COAGUL
CRANIOTOMY W/ELEVATION, BONE FLAP; EXCISION, CRANI
CRANIOTOMY, HYPOPHYSECTOMY/EXCISION, PITUITARY TUM
HYPOPHYSECTOMY/EXCISION, PITUITARY TUMOR, TRANSNAS
CRANIECTOMY, CRANIOSYNOSTOSIS; SINGLE CRANIAL SUTU
CRANIECTOMY, CRANIOSYNOSTOSIS; MULTIPLE CRANIAL SU
CRANIOTOMY, CRANIOSYNOSTOSIS; FRONTAL/PARIETAL BON
CRANIOTOMY, CRANIOSYNOSTOSIS; BIFRONTAL BONE FLAP
EXTENSIVE CRANIECTOMY, MULTIPLE CRANIAL SUTURE CRA
EXTENSIVE CRANIECTOMY, MULTIPLE CRANIAL SUTURE CRA
EXCISION, BENIGN TUMOR, CRANIAL BONE; W/O OPTIC NE
EXCISION, BENIGN TUMOR, CRANIAL BONE; W/OPTIC NERV
CRANIOTOMY W/ELEVATION, BONE FLAP; SELECTIVE AMYGD
CRANIOTOMY W/ELEVATION, BONE FLAP; MULTIPLE SUBPIA
CRANIECTOMY/CRANIOTOMY; W/EXCISION, FB, BRAIN
CRANIECTOMY/CRANIOTOMY; W/TREATMENT, PENETRATING W
TRANSORAL APPROACH TO SKULL BASE, BX/DECOMPRESSION
TRANSORAL APPROACH TO SKULL BASE, BX/DECOMPRES/EXC
CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; E
CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; E
CRANIOFACIAL APPROACH TO ANTERIOR CRANIAL FOSSA; E
CRANIOFACIAL APPROACH TO ANT CRANIAL FOSSA; INTRAD
ORBITOCRANIAL APPROACH TO ANTERIOR CRANIAL FOSSA;
ORBITOCRANIAL APPROACH TO ANTERIOR CRANIAL FOSSA;
BICORONAL TRANSZYGOMATIC AND/OR LEFORT I APPROACH,
INFRATEMPORAL PRE-AURICULAR APPROACH TO MIDDLE CRA
INFRATEMPORAL POST-AURICULAR APPROACH TO MIDDLE CR
ORBITOCRANIAL ZYGOMATIC APPROACH TO MIDDLE CRANIAL
TRANSTEMPORAL APPROACH TO POSTERIOR CRANIAL FOSSA/
TRANSCOCHLEAR APPROACH TO POSTERIOR CRANIAL FOSSA/
TRANSCONDYLAR APPROACH TO POSTERIOR CRANIAL FOSSA/
TRANSPETROSAL APPROACH TO POSTERIOR CRANIAL FOSSA/
RESECT/EXCISE, LESION, BASE, ANTERIOR CRANIAL FOSS
RESECT/EXCISE, LESION, BASE, ANTERIOR CRANIAL FOSS
RESECT/EXCISE, LESION, INFRATEMPORAL FOSSA/PARAPHA
RESECT/EXCISE, LESION, INFRATEMPORAL FOSSA/PARAPHA
RESECT/EXCISE, LESION, PARASELLAR AREA/CAVERNOUS S
RESECT/EXCISE, LESION, PARASELLAR AREA/CAVERNOUS S
TRNSXJ/LIG CAROTID ARTERY SINUS W/RPR ANAST/GRFT
TRANSECTION/LIGATION, CAROTID ARTERY IN PETROUS CA
TRANSECTION/LIGATION, CAROTID ARTERY IN PETROUS CA
OBLITERATION, CAROTID ANEURYSM/AVM/CAROTID-CAVERNO
RESECT/EXCISE, LESION, BASE POSTERIOR CRANIAL FOSS
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
61616
61618
61619
61623
61624
61626
61630
61635
61640
61641
61642
61645
61650
61651
61680
61682
61684
61686
61690
61692
61697
61698
61700
61702
61703
61705
61708
61710
61711
61720
61735
61750
61751
61760
61770
61781
61782
61783
61790
61791
61796
61797
61798
61799
61800
61850
61860
61863
61864
61867
61868
61870
61880
61885
61886
61888
62000
62005
62010
62100
62115
62117
62120
62121
62140
62141
62142
62143
62145
62146
62147
62148
62160
62161
62162
62163
62164
62165
62180
62190
62192
62194
62200
62201
62220
62223
62225
62230
62252
62256
62258
RESECT/EXCISE, LESION, BASE POSTERIOR CRANIAL FOSS
SECONDARY REPAIR, CSF LEAK/CRANIAL FOSSA; FREE TIS
SECONDARY REPAIR, CSF LEAK/CRANIAL FOSSA; LOCAL/RE
ENDOVASC TEMP OCCLUSION, HEAD/NCK W/VESSEL CATH, B
TRANSCATHETER PERM OCCLUSION/EMBOLIZATION, PERCUTA
TRANSCATHETER PERM OCCLUSION/EMBOLIZATION, PERCUTA
BALLOON ANGIOPLASTY, INTRACRANIAL, PERCUTANEOUS
TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT, IN
BALLOON DILATATION OF INTRA VASOSPASM PERCUTANEOUS
BALLOON DILATATION OF INTRA VASOSPASM PERCUTANEOUS
BALLOON DILATATION OF INTRA VASOSPASM PERCUTANEOUS
PERCUTANEOUS ARTERIAL TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION
ENDOVASCULAR INTRACRANIAL PROLONGED ADMINISTRATION OF PHARMACOLOGIC AGENT(
ENDOVASCULAR INTRACRANIAL PROLONGED ADMINISTRATION OF PHARMACOLOGIC AGENT(
SURGERY, INTRACRANIAL ARTERIOVENOUS MALFORMATION;
SURGERY, INTRACRANIAL ARTERIOVENOUS MALFORMATION;
SURGERY, INTRACRANIAL ARTERIOVENOUS MALFORMATION;
SURGERY, INTRACRANIAL ARTERIOVENOUS MALFORMATION;
SURGERY, INTRACRANIAL ARTERIOVENOUS MALFORMATION;
SURGERY, INTRACRANIAL ARTERIOVENOUS MALFORMATION;
SURGERY, INTRACRANIAL ANEURYSM, COMPLEX, INTRACRAN
SURGERY, INTRACRANIAL ANEURYSM, COMPLEX, INTRACRAN
SURGERY, INTRACRANIAL ANEURYSM, SIMPLE, INTRACRANI
SURGERY, SIMPLE INTRACRANIAL ANEURYSM, INTRACRANIA
SURGERY, INTRACRANIAL ANEURYSM, CERVICAL APPROACH,
SURGERY, ANEURYSM, VASCULAR MALFORMATION; OCCLUSIO
SURGERY, ANEURYSM, VASCULAR MALFORMATION; INTRACRA
SURGERY, ANEURYSM, VASCULAR MALFORMATION; INTRA-AR
ANASTOMOSIS, ARTERIAL, EXTRACRANIAL-INTRACRANIAL A
CREATION, LESION, STEREOTACTIC W/BURR HOLE(S), SIN
CREATION, LESION, STEREOTACTIC W/BURR HOLE(S), SIN
STEREOTACTIC BX, ASPIRATION/EXCISION, W/BURR HOLE(
STEREOTACTIC BX/ASPIRATION/EXCISION, W/BURR HOLE(S
STEREOTACTIC IMPLANTATION, DEPTH ELECTRODES, CEREB
STEREOTACTIC LOCALIZATION, W/INSERTION, CATHETER/P
STRTCTC CPTR ASSTD PX IDRL CRNL
STRTCTC CPTR ASSTD PX XDRL CRNL
STRTCTC CPTR ASSTD PX SPINAL
CREATION, LESION, STEREOTACTIC, PERCUTANEOUS, NEUR
CREATION, LESION, STEREOTACTIC, PERCUTANEOUS, NEUR
STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES
STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE
STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES
STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX
APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY
TWIST DRILL/BURR HOLE(S), IMPLANTATION, NEUROSTIMU
CRANIECTOMY/CRANIOTOMY, IMPLANTATION, NEUROSTIMULA
STEREOTACTIC IMPLANT NEUROSTIM ELECTRODE ARRAY, SU
STEREOTACTIC IMPLANT NEUROSTIM ELECTRODE ARRAY, SU
STEREOTACTIC IMPLANT NEUROSTIM ELECTRODE ARRAY, SU
STEREOTACTIC IMPLANT NEUROSTIM ELECTRODE ARRAY, SU
CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR CORTICAL
REVISION/REMOVAL, INTRACRANIAL NEUROSTIMULATOR ELE
SUBQ PLACEMENT CRANIAL NEUROSTIMULATOR PULSE GENER
SUBQ PLACEMENT CRANIAL NEUROSTIMULATOR PULSE GENER
REVISION/REMOVAL, CRANIAL NEUROSTIMULATOR PULSE GE
ELEVATION, DEPRESSED SKULL FX; SIMPLE, EXTRADURAL
ELEVATION, DEPRESSED SKULL FX; COMPOUND/COMMINUTED
ELEVATION, DEPRESSED SKULL FX; W/REPAIR, DURA AND/
CRANIOTOMY, REPAIR, DURAL/CSF LEAK, W/SURGERY, RHI
REDUCTION, CRANIOMEGALIC SKULL; NO BONE GRAFTS/CRA
REDUCTION, CRANIOMEGALIC SKULL; W/CRANIOTOMY/RECON
REPAIR, ENCEPHALOCELE, SKULL VAULT, W/CRANIOPLASTY
CRANIOTOMY, REPAIR, ENCEPHALOCELE, SKULL BASE
CRANIOPLASTY, SKULL DEFECT; UP TO 5 CM DIAMETER
CRANIOPLASTY, SKULL DEFECT; GREATER THAN 5 CM DIAM
REMOVAL, BONE FLAP/PROSTHETIC PLATE, SKULL
REPLACEMENT, BONE FLAP/PROSTHETIC PLATE, SKULL
CRANIOPLASTY, SKULL DEFECT W/REPARATIVE BRAIN SURG
CRANIOPLASTY W/AUTOGRAFT (INCLUDES OBTAINING BONE
CRANIOPLASTY W/AUTOGRAFT (INCLUDES OBTAINING BONE
INCISION AND RETRIEVAL SUBQ CRANIAL BONE GRAFT FOR
NEUROENDOSCOPY, INTRACRANIAL, PLACE/REPLACE VENTRI
NEUROENDOSCOPY, INTRACRANIAL; W/O DISSECT ADHESION
NEUROENDSCOPY, INTRACRANIAL; W/FENESTRATION/EXCISE
NEUROENDOSCOPY, INTRACRANIAL; W/RETRIEVAL, FB
NEUROENDOSCOPY, INTRACRANIAL; W/EXCISE BRAIN TUMOR
NEUROENDOSCOPY, INTRACRANIAL; W/EXCISE, PITUITARY
VENTRICULOCISTERNOSTOMY (TORKILDSEN TYPE OPERATION
CREATION, SHUNT; SUBARACHNOID/SUBDURAL-ATRIAL, -JU
CREATION, SHUNT; SUBARACHNOID/SUBDURAL-PERITONEAL,
REPLACEMENT/IRRIGATION, SUBARACHNOID/SUBDURAL CATH
VENTRICULOCISTERNOSTOMY, 3RD VENTRICLE
VENTRICULOCISTERNOSTOMY, 3RD VENTRICLE; STEREOTACT
CREATION, SHUNT; VENTRICULO-ATRIAL, -JUGULAR, -AUR
CREATION, SHUNT; VENTRICULO-PERITONEAL, -PLEURAL,
REPLACEMENT/IRRIGATION, VENTRICULAR CATHETER
REPLACEMENT/REVISION, CSF SHUNT, OBSTRUCTED VALVE/
REPROGRAMMING, PROGRAMMABLE CSF SHUNT
REMOVAL, COMPLETE CSF SHUNT SYSTEM; W/O REPLACEMEN
REMOVAL, COMPLETE CSF SHUNT SYSTEM; W/REPLACEMENT
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2016
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
62263
62264
62267
62268
62269
62270
62272
62273
62280
62281
62282
62284
62287
62290
62291
62292
62294
62302
62303
62304
62305
62310
62311
62318
62319
62350
62351
62355
62360
62361
62362
62365
62367
62368
62369
62370
63001
63003
63005
63011
63012
63015
63016
63017
63020
63030
63035
63040
63042
63043
63044
63045
63046
63047
63048
63050
63051
63055
63056
63057
63064
63066
63075
63076
63077
63078
63081
63082
63085
63086
63087
63088
63090
63091
63101
63102
63103
63170
63172
63173
63180
63182
63185
63190
63191
63194
63195
63196
63197
63198
63199
LYSIS, PERQ, EPIDURAL ADHESIONS, SOLUTION INJECTIO
LYSIS, PERQ, EPIDURAL ADHESIONS, SOLUTION INJECTIO
PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS
PERCUTANEOUS ASPIRATION, SPINAL CORD CYST/SYRINX
BX, SPINAL CORD, PERCUTANEOUS NEEDLE
SPINAL PUNCTURE, LUMBAR, DX
SPINAL PUNCTURE, THERAPEUTIC, DRAINAGE, SPINAL FLU
INJECTION, EPIDURAL, BLOOD/CLOT PATCH
INJECTION/INFUSION NEUROLYTIC SUBSTANCE, W/WO THER
INJECTION/INFUSION NEUROLYTIC SUBSTANCE, W/WO THER
INJECTION/INFUSION NEUROLYTIC SUBSTANCE, W/WO THER
INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR
DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR
INJECTION, DISKOGRAPHY, EACH LEVEL; LUMBAR
INJECTION, DISKOGRAPHY, EACH LEVEL; CERVICAL/THORA
INJECTION, CHEMONUCLEOLYSIS, W/DISKOGRAPHY, LUMBAR
INJECTION, ARTERIAL, OCCLUSION, ARTERIOVENOUS MALF
MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL
MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC
MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL
MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS
NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC
NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL
NJXS INFUS/BOLUS DX/SBST EDRL/SUBARACH CRV/THRC
NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL
IMPLANT/REVISN/REPOSITION INTRATHECAL/EPIDURAL CAT
IMPLANT/REVISN/REPOSITION INTRATHECAL/EPIDURAL CAT
REMOVAL, PREVIOUSLY IMPLANTED INTRATHECAL/EPIDURAL
IMPLANTATION/REPLACE, DEVICE, INTRATHECAL/EPIDURAL
IMPLANTATION/REPLACE, DEVICE, INTRATHECAL/EPIDURAL
IMPLANTATION/REPLACE, DEVICE, INTRATHECAL/EPIDURAL
REMOVAL, SUBQ RESERVOIR/PUMP
ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL
ELECTRONIC ANALYSIS, PROGRAMMABLE PUMP; W/REPROGRA
ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFILL
ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP
LAMINECTOMY, W/O FACETECTOMY/FORAMINOTOMY/DISKECTO
LAMINECTOMY, W/O FACETECTOMY/FORAMINOTOMY/DISKECTO
LAMINECTOMY, W/O FACETECTOMY/FORAMINOTOMY/DISKECTO
LAMINECTOMY, W/O FACETECTOMY/FORAMINOTOMY/DISKECTO
LAMINECTOMY, W/REMOVAL, ABNORMAL FACETS, LUMBAR
LAMINECTOMY, W/O FACETECTOMY/FORAMINOTOMY/DISKECTO
LAMINECTOMY, W/O FACETECTOMY/FORAMINOTOMY/DISKECTO
LAMINECTOMY W/O FACETECTOMY/FORAMINOTOMY/DISKECTOM
LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC
LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR
LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR
LAMINOTOMY W/PARTL FACETECTMY/FORAMNOTMY/HERNIATED
LAMINOTOMY W/PARTL FACETECTOMY/FORAMINOTOMY/HERNIA
LAMINOTMY W/PARTL FACETECT/FORAMNOTMY/HERN DISKECT
LAMINOTMY W/PARTL FACETECT/FORAMNOTMY/HERN DISKECT
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY, 1 SEGME
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY, 1 SEGME
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY, 1 SEGME
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY; ADDL SE
LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION , 2 OR
LAMINOPLASTY, CERVICAL, WITH RECONSTRUCTION OF THE
TRANSPEDICULAR APPROACH, 1 SEGMENT; THORACIC
TRANSPEDICULAR APPROACH, 1 SEGMENT; LUMBAR (TRANSF
TRANSPEDICULAR APPROACH, ADDL SEGMENT; THORACIC/LU
COSTOVERTEBRAL APPROACH, THORACIC; 1 SEGMENT
COSTOVERTEBRAL APPROACH, THORACIC; ADDL SEGMENT
DISKECTOMY, ANTERIOR; CERVICAL, 1 INTERSPACE
DISKECTOMY, ANTERIOR; CERVICAL, ADDL INTERSPACE
DISKECTOMY, ANTERIOR; THORACIC, 1 INTERSPACE
DISKECTOMY, ANTERIOR; THORACIC, ADDL INTERSPACE
VERTEBRAL CORPECTOMY, ANTERIOR; CERVICAL, 1 SEGMEN
VERTEBRAL CORPECTOMY, ANTERIOR; CERVICAL, ADDL SEG
VERTEBRAL CORPECTOMY, TRANSTHORACIC; THORACIC, 1 S
VERTEBRAL CORPECTOMY, TRANSTHORACIC; THORACIC, ADD
VERTEBRAL CORPECTOMY, THORACOLUMBAR, LOWER THORACI
VERTEBRAL CORPECTOMY, THORACOLUMBAR, LOWER THORACI
VERTEBRAL CORPECTOMY, TRANSPERITONEAL/RETROPERITON
VERTEBRAL CORPECTOMY, TRANS/RETROPERITONEAL, LOWER
VERTEBRAL CORPECTOMY, LAT EXTRACAVITARY W/DECOMPRE
VERTEBRAL CORPECTOMY, LAT EXTRACAVITARY W/DECOMPRE
VERTEBRAL CORPECTOMY, LAT EXTRACAVITARY W/DECOMPRE
LAMINECTOMY W/MYELOTOMY, CERVICAL, THORACIC/THORAC
LAMINECTOMY W/DRAINAGE, INTRAMEDULLARY CYST/SYRINX
LAMINECTOMY W/DRAINAGE, INTRAMEDULLARY CYST/SYRINX
LAMINECTOMY/SECTION, DENTATE LIGAMENTS, CERVICAL;
LAMINECTOMY/SECTION, DENTATE LIGAMENTS, CERVICAL;
LAMINECTOMY, W/RHIZOTOMY; 1/2 SEGMENTS
LAMINECTOMY, W/RHIZOTOMY; OVER 2 SEGMENTS
LAMINECTOMY, W/SECTION, SPINAL ACCESSORY NERVE
LAMINECTOMY, W/CORDOTOMY, W/SECTION, ONE SPINOTHAL
LAMINECTOMY, W/CORDOTOMY, W/SECTION, ONE SPINOTHAL
LAMINECTOMY, W/CORDOTOMY, W/SECTION, BOTH SPINOTHA
LAMINECTOMY, W/CORDOTOMY, W/SECTION, BOTH SPINOTHA
LAMINECTOMY, W/CORDOTOMY, W/SECTION, BOTH SPINOTHA
LAMINECTOMY, W/CORDOTOMY, W/SECTION, BOTH SPINOTHA
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
63200
63250
63251
63252
63265
63266
63267
63268
63270
63271
63272
63273
63275
63276
63277
63278
63280
63281
63282
63283
63285
63286
63287
63290
63295
63300
63301
63302
63303
63304
63305
63306
63307
63308
63600
63610
63615
63620
63621
63650
63655
63661
63662
63663
63664
63685
63688
63700
63702
63704
63706
63707
63709
63710
63740
63741
63744
63746
64400
64402
64405
64408
64410
64412
64413
64415
64416
64417
64418
64420
64421
64425
64430
64435
64445
64446
64447
64448
64449
64450
64455
64461
64462
64463
64479
64480
64483
64484
64486
64487
64488
LAMINECTOMY, W/RELEASE, TETHERED SPINAL CORD, LUMB
LAMINECTOMY, EXCISION/OCCLUSION, AVM, SPINAL CORD;
LAMINECTOMY, EXCISION/OCCLUSION, AVM, SPINAL CORD;
LAMINECTOMY, EXCISION/OCCLUSION, AVM, SPINAL CORD;
LAMINECTOMY, EXCISION, NON-NEOPLASTIC LESION, EXTR
LAMINECTOMY, EXCISION, NON-NEOPLASTIC LESION, EXTR
LAMINECTOMY, EXCISION, NON-NEOPLASTIC LESION, EXTR
LAMINECTOMY, EXCISION, NON-NEOPLASTIC LESION, EXTR
LAMINECTOMY, EXCISION, INTRASPINAL LESION OTHER TH
LAMINECTOMY, EXCISION, INTRASPINAL LESION OTHER TH
LAMINECTOMY, EXCISION, INTRASPINAL LESION OTHER TH
LAMINECTOMY, EXCISION, INTRASPINAL LESION OTHER TH
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; EX
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; EX
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; EX
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; EX
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; IN
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; IN
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; IN
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; IN
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; IN
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; IN
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; IN
LAMINECTOMY, BX/EXCISION, INTRASPINAL NEOPLASM; EX
OSTEOPLASTIC RECONSTRUCTION OF DORSAL SPINE ELEMEN
VERTEBRAL CORPECTOMY, 1 SEGMENT; EXTRADURAL, CERVI
VERTEBRAL CORPECTOMY, 1 SEGMENT; EXTRADURAL, THORA
VERTEBRAL CORPECTOMY, 1 SEGMENT; EXTRADURAL, THORA
VERTEBRAL CORPECTOMY, 1 SEGMENT; EXTRADURAL, LUMBA
VERTEBRAL CORPECTOMY, 1 SEGMENT; INTRADURAL, CERVI
VERTEBRAL CORPECTOMY, 1 SEGMENT; INTRADURAL, THORA
VERTEBRAL CORPECTOMY, 1 SEGMENT; INTRADURAL, THORA
VERTEBRAL CORPECTOMY, 1 SEGMENT; INTRADURAL, LUMBA
VERTEBRAL CORPECTOMY, ADDL SEGMENT
CREATION, LESION, SPINAL CORD, STEREOTACTIC, PERCU
STEREOTACTIC STIMULATION, SPINAL CORD, PERCUTANEOU
STEREOTACTIC BX, ASPIRATION/EXCISION, LESION, SPIN
STEREOTACTIC RADIOSURGERY 1 SPINAL LESION
STEREOTACTIC RADIOSURGERY EA ADDL SPINAL LESION
PERCUTANEOUS IMPLANTATION, NEUROSTIMULATOR ELECTRO
LAMINECTOMY, IMPLANTATION, NEUROSTIMULATOR ELECTRO
RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR
RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR
REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR
REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR
INCISION/PLACEMENT, SPINAL NEUROSTIMULATOR PULSE G
REVISION/REMOVAL, IMPLANTED SPINAL NEUROSTIMULATOR
REPAIR, MENINGOCELE; LESS THAN 5 CM DIAMETER
REPAIR, MENINGOCELE; LARGER THAN 5 CM DIAMETER
REPAIR, MYELOMENINGOCELE; LESS THAN 5 CM DIAMETER
REPAIR, MYELOMENINGOCELE; GREATER 5 CM DIAMETER
REPAIR, DURAL/CSF LEAK, NOT REQUIRING LAMINECTOMY
REPAIR, DURAL/CSF LEAK, PSEUDOMENINGOCELE, W/LAMIN
DURAL GRAFT, SPINAL
CREATION, SHUNT, LUMBAR/SUBARACHNOID-PERITONEAL/PL
CREATION, SHUNT, LUMBAR/SUBARACHNOID-PERITONEAL/PL
REPLACEMENT, IRRIGATION/REVISION, LUMBOSUBARACHNOI
REMOVAL, ENTIRE LUMBOSUBARACHNOID SHUNT SYSTEM W/O
INJECTION, ANESTHETIC AGENT; TRIGEMINAL NERVE, ANY
INJECTION, ANESTHETIC AGENT; FACIAL NERVE
INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NER
INJECTION, ANESTHETIC AGENT; VAGUS NERVE
INJECTION, ANESTHETIC AGENT; PHRENIC NERVE
INJECTION, ANESTHETIC AGENT; SPINAL ACCESSORY NERV
INJECTION, ANESTHETIC AGENT; CERVICAL PLEXUS
INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, SING
INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, CONT
INJECTION, ANESTHETIC AGENT; AXILLARY NERVE
INJECTION, ANESTHETIC AGENT; SUPRASCAPULAR NERVE
INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SI
INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVES, M
INJECTION, ANESTHETIC AGENT; ILIOINGUINAL, ILIOHYP
INJECTION, ANESTHETIC AGENT; PUDENDAL NERVE
INJECTION, ANESTHETIC AGENT; PARACERVICAL (UTERINE
INJECTION, ANESTHETIC AGENT; SCIATIC NERVE, SINGLE
INJECTION, ANESTHETIC AGENT; SCIATIC NERVE, CONT C
INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, SINGLE
INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, CONT C
INJECTION, ANESTHETIC AGENT; LUMBAR PLEXUS, POSTER
INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERV
NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE
PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SINGLE INJECTION SITE (INC
PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SECOND AND ANY ADDITION
PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; CONTINUOUS INFUSION BY
NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL
NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LVL
NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL
NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LVL
TAP BLOCK UNILATERAL BY INJECTION(S)
TAP BLOCK UNILATERAL BY CONTINUOUS INFUSION(S)
TAP BLOCK BILATERAL BY INJECTION(S)
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2016
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2015
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
64489
64490
64491
64492
64493
64494
64495
64505
64508
64510
64517
64520
64530
64550
64553
64555
64561
64565
64566
64568
64569
64570
64575
64580
64581
64585
64590
64595
64600
64605
64610
64611
64612
64615
64616
64617
64620
64630
64632
64633
64634
64635
64636
64640
64642
64643
64644
64645
64646
64647
64650
64653
64680
64681
64702
64704
64708
64712
64713
64714
64716
64718
64719
64721
64722
64726
64727
64732
64734
64736
64738
64740
64742
64744
64746
64755
64760
64763
64766
64771
64772
64774
64776
64778
64782
64783
64784
64786
64787
64788
64790
TAP BLOCK BILATERAL BY CONTINUOUS INFUSION(S)
NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLI
INJECTION, ANESTHETIC AGENT; CAROTID SINUS (SEP PR
INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CE
INJECTION, ANESTHETIC AGENT; SUPERIOR HYPOGASTRIC
INJECTION, ANESTHETIC AGENT; LUMBAR/THORACIC (PARA
INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, W/WO R
APPLICATION, SURFACE (TRANSCUTANEOUS) NEUROSTIMULA
PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE
PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV
PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING
PRQ IMPLTJ NSTIM ELTRD NEUROMUSCULAR
POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER
REVISION/REPLMT NSTIM CRNL ELTRDS
REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATOR
INC IMPLTJ PERIPH NERVE NEUROSTIMULATOR ELTRD
INC IMPLTJ NSTIM ELTRD NEUROMUSCULAR
INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECT
REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE
INCISION AND SUBQ PLACEMENT, PERIPHERAL NEUROSTIMU
REVISION/REMOVAL, PERIPHERAL NEUROSTIMULATOR PULSE
DESTRUCTION, NEUROLYTIC, TRIGEMINAL NERVE; SUPRAOR
DESTRUCTION, NEUROLYTIC, TRIGEMINAL NERVE; 2ND AND
DESTRUCTION, NEUROLYTIC, TRIGEMINAL NERVE; 2ND AND
CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS BI
CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG
DESTRUCTION, NEUROLYTIC, INTERCOSTAL NERVE
DESTRUCTION, NEUROLYTIC; PUDENDAL NERVE
DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE
DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
DESTRUCTION, NEUROLYTIC; OTHER PERIPHERAL NERVE/BR
CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE
CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE
CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES
CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES
CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES
CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES
CHEMODENERVATION OF ECCRINE GLANDS; BOTH AXILLAE
CHEMODENERVATION OF ECCRINE GLANDS; OTHER AREA; PE
DESTRUCTION, NEUROLYTIC AGENT, W/WO RADIOLOGIC MON
DESTRUCTION, NEUROLYTIC AGENT, W/WO RADIOLOGIC MON
NEUROPLASTY; DIGITAL, ONE/BOTH, SAME DIGIT
NEUROPLASTY; NERVE, HAND/FOOT
NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC
NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV
NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS
NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS
NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (S
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT E
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT W
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT
DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY)
DECOMPRESSION; PLANTAR DIGITAL NERVE
INT NEUROLYSIS, W/MICROSCOPE
TRANSECTION/AVULSION; SUPRAORBITAL NERVE
TRANSECTION/AVULSION; INFRAORBITAL NERVE
TRANSECTION/AVULSION; MENTAL NERVE
TRANSECTION/AVULSION; INFERIOR ALVEOLAR NERVE, OST
TRANSECTION/AVULSION; LINGUAL NERVE
TRANSECTION/AVULSION; FACIAL NERVE, DIFFERENTIAL/C
TRANSECTION/AVULSION; GREATER OCCIPITAL NERVE
TRANSECTION/AVULSION; PHRENIC NERVE
TRANSECTION/AVULSION; VAGUS NERVES, PROXIMAL STOMA
TRANSECTION/AVULSION; VAGUS NERVE (VAGOTOMY), ABDO
TRANSECTION/AVULSION, OBTURATOR NERVE, EXTRAPELVIC
TRANSECTION/AVULSION, OBTURATOR NERVE, INTRAPELVIC
TRANSECTION/AVULSION, OTHER CRANIAL NERVE, EXTRADU
TRANSECTION/AVULSION, OTHER SPINAL NERVE, EXTRADUR
EXCISION, NEUROMA; CUTANEOUS NERVE, SURGICALLY IDE
EXCISION, NEUROMA; DIGITAL NERVE, ONE/BOTH, SAME D
EXCISION, NEUROMA; DIGITAL NERVE, ADDL DIGIT
EXCISION, NEUROMA; HAND/FOOT, EXCEPT DIGITAL NERVE
EXCISION, NEUROMA; HAND/FOOT, ADDL NERVE, EXCEPT S
EXCISION, NEUROMA; MAJOR PERIPHERAL NERVE, EXCEPT
EXCISION, NEUROMA; SCIATIC NERVE
IMPLANTATION, NERVE END INTO BONE/MUSCLE
EXCISION, NEUROFIBROMA/NEUROLEMMOMA; CUTANEOUS NER
EXCISION, NEUROFIBROMA/NEUROLEMMOMA; MAJOR PERIPHE
1/1/2015
1/1/2010
1/1/2010
1/1/2010
1/1/2010
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2013
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2009
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
64792
64795
64802
64804
64809
64818
64820
64821
64822
64823
64831
64832
64834
64835
64836
64837
64840
64856
64857
64858
64859
64861
64862
64864
64865
64866
64868
64872
64874
64876
64885
64886
64890
64891
64892
64893
64895
64896
64897
64898
64901
64902
64905
64907
64910
64911
64999
65091
65093
65101
65103
65105
65110
65112
65114
65125
65130
65135
65140
65150
65155
65175
65205
65210
65220
65222
65235
65260
65265
65270
65272
65273
65275
65280
65285
65286
65290
65400
65410
65420
65426
65430
65435
65436
65450
65600
65710
65730
65750
65755
65756
EXCISION, NEUROFIBROMA/NEUROLEMMOMA; EXTENSIVE (W/
BX, NERVE
SYMPATHECTOMY, CERVICAL
SYMPATHECTOMY, CERVICOTHORACIC
SYMPATHECTOMY, THORACOLUMBAR
SYMPATHECTOMY, LUMBAR
SYMPATHECTOMY; DIGITAL ARTERIES, EACH DIGIT
SYMPATHECTOMY; RADIAL ARTERY
SYMPATHECTOMY; ULNAR ARTERY
SYMPATHECTOMY; SUPERFICIAL PALMAR ARCH
SUTURE, DIGITAL NERVE, HAND/FOOT; ONE NERVE
SUTURE, DIGITAL NERVE, HAND/FOOT; ADDL DIGITAL NER
SUTURE, 1 NERVE, HAND/FOOT; COMMON SENSORY NERVE
SUTURE, 1 NERVE, HAND/FOOT; MEDIAN MOTOR THENAR
SUTURE, 1 NERVE, HAND/FOOT; ULNAR MOTOR
SUTURE, ADDL NERVE, HAND/FOOT
SUTURE, POSTERIOR TIBIAL NERVE
SUTURE, MAJOR PERIPHERAL NERVE, ARM/LEG, EXCEPT SC
SUTURE, MAJOR PERIPHERAL NERVE, ARM/LEG, EXCEPT SC
SUTURE, SCIATIC NERVE
SUTURE, ADDL MAJOR PERIPHERAL NERVE
SUTURE; BRACHIAL PLEXUS
SUTURE; LUMBAR PLEXUS
SUTURE, FACIAL NERVE; EXTRACRANIAL
SUTURE, FACIAL NERVE; INFRATEMPORAL, W/WO GRAFTING
ANASTOMOSIS; FACIAL-SPINAL ACCESSORY
ANASTOMOSIS; FACIAL-HYPOGLOSSAL
SUTURE, NERVE; W/SECONDARY/DELAYED SUTURE
SUTURE, NERVE; W/EXTENSIVE MOBILIZATION/TRANSPOSIT
SUTURE, NERVE; W/SHORTENING, BONE, EXTREMITY
NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD/NECK;
NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD/NECK;
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STR
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STR
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STR
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STR
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE S
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE S
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE S
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE S
NERVE GRAFT (INCLUDES OBTAINING GRAFT), ADDL NERVE
NERVE GRAFT (INCLUDES OBTAINING GRAFT), ADDL NERVE
NERVE PEDICLE TRANSFER; 1ST STAGE
NERVE PEDICLE TRANSFER; 2ND STAGE
Nerve repair w/allograft
Neurorraphy w/vein autograft
UNLISTED PROC, NERVOUS SYSTEM
EVISCERATION, OCULAR CONTENTS; W/O IMPLANT
EVISCERATION, OCULAR CONTENTS; W/IMPLANT
ENUCLEATION, EYE; W/O IMPLANT
ENUCLEATION, EYE; W/IMPLANT, MUSCLES NOT ATTACHED
ENUCLEATION, EYE; W/IMPLANT, MUSCLES ATTACHED TO I
EXENTERATION, ORBIT (DOES NOT INCLUDE SKIN GRAFT),
EXENTERATION, ORBIT (DOES NOT INCLUDE SKIN GRAFT);
EXENTERATION, ORBIT (DOES NOT INCLUDE SKIN GRAFT);
MODIFICATION, OCULAR IMPLANT W/PLACEMENT/REPLACEME
INSERTION, OCULAR IMPLANT SECONDARY; AFTER EVISCER
INSERTION, OCULAR IMPLANT SECONDARY; AFTER ENUCLEA
INSERTION, OCULAR IMPLANT SECONDARY; AFTER ENUCLEA
REINSERTION, OCULAR IMPLANT; W/WO CONJUNCTIVAL GRA
REINSERTION, OCULAR IMPLANT; W/REINFORCEMENT AND/O
REMOVAL, OCULAR IMPLANT
REMOVAL, FB, EXT EYE; CONJUNCTIVAL SUPERFICIAL
REMOVAL, FB, EXT EYE; CONJUNCTIVAL EMBEDDED/SUBCON
REMOVAL, FB, EXT EYE; CORNEAL, W/O SLIT LAMP
REMOVAL, FB, EXT EYE; CORNEAL, W/SLIT LAMP
REMOVAL, FB, INTRAOCULAR; ANTERIOR CHAMBER/LENS
REMOVAL, FB, INTRAOCULAR; POSTERIOR SEGMENT, MAGNE
REMOVAL, FB, INTRAOCULAR; POSTERIOR SEGMENT, NONMA
REPAIR, LACERATION; CONJUNCTIVA, W/WO LACERATED SC
REPAIR, LACERATION; CONJUNCTIVA, MOBILIZATION AND
REPAIR, LACERATION; CONJUNCTIVA, MOBILIZATION AND
REPAIR, LACERATION; CORNEA, NONPERFORATING, W/WO R
REPAIR, LACERATION; CORNEA AND/OR SCLERA, PERFORAT
REPAIR, LACERATION; CORNEA AND/OR SCLERA, PERFORAT
REPAIR, LACERATION; APPLICATION, TISSUE GLUE, WOUN
REPAIR, WOUND, EXTRAOCULAR MUSCLE, TENDON AND/OR T
EXCISION, LESION, CORNEA (KERATECTOMY, LAMELLAR, P
BX, CORNEA
EXCISION/TRANSPOSITION, PTERYGIUM; W/O GRAFT
EXCISION/TRANSPOSITION, PTERYGIUM; W/GRAFT
SCRAPING, CORNEA, DX, SMEAR AND/OR CULTURE
REMOVAL, CORNEAL EPITHELIUM; W/WO CHEMOCAUTERIZATI
REMOVAL, CORNEAL EPITHELIUM; W/APPLICATION, CHELAT
DESTRUCTION, LESION, CORNEA, CRYOTHERAPY, PHOTOCOA
MULTIPLE PUNCTURES, ANTERIOR CORNEA
KERATOPLASTY (CORNEAL TRANSPLANT); LAMELLAR
KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (EX
KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN
KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN
KERATOPLASTY ENDOTHELIAL
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
65757
65760
65765
65767
65770
65771
65772
65775
65778
65779
65780
65781
65782
65785
65800
65810
65815
65820
65850
65855
65860
65865
65870
65875
65880
65900
65920
65930
66020
66030
66130
66150
66155
66160
66170
66172
66174
66175
66179
66180
66183
66184
66185
66220
66225
66250
66500
66505
66600
66605
66625
66630
66635
66680
66682
66700
66710
66711
66720
66740
66761
66762
66770
66820
66821
66825
66830
66840
66850
66852
66920
66930
66940
66982
66983
66984
66985
66986
66990
66999
67005
67010
67015
67025
67027
67028
67030
67031
67036
67039
67040
BACKBENCH PREPJ CORNEAL ENDOTHELIAL ALLOGRAFT
KERATOMILEUSIS
KERATOPHAKIA
EPIKERATOPLASTY
KERATOPROSTHESIS
RADIAL KERATOTOMY
CORNEAL RELAXING INCISION, CORRECTION, SURGICALLY
CORNEAL WEDGE RESECTION, CORRECTION, SURGICALLY IN
PLACE AMNIOTIC MEMBRA OCULAR SURFACE W/O SUTURES
PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED
OCULAR SURFACE RECONSTRUCTION AMNIOTIC MEMBRANE
OCULAR SURFACE RECONSTRUCTION; LIMBAL STEM CELL AL
OCULAR SURFACE RECONSTRUCTION; LIMBAL CONJUNCTIVAL
IMPLANTATION OF INTRASTROMAL CORNEAL RING SEGMENTS
PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX
PARACENTESIS, EYE, ANTERIOR CHAMBER (SEP PROC); W/
PARACENTESIS, EYE, ANTERIOR CHAMBER (SEP PROC); W/
GONIOTOMY
TRABECULOTOMY AB EXTERNO
TRABECULOPLASTY BY LASER SURGERY, 1 OR MORE SESSIO
SEVERING ADHESIONS, ANTERIOR SEGMENT, LASER TECHNI
SEVERING ADHESIONS, ANTERIOR SEGMENT, EYE, INCISIO
SEVERING ADHESIONS, ANTERIOR SEGMENT, EYE, INCISIO
SEVERING ADHESIONS, ANTERIOR SEGMENT, EYE, INCISIO
SEVERING ADHESIONS, ANTERIOR SEGMENT, EYE, INCISIO
REMOVAL, EPITHELIAL DOWNGROWTH, ANTERIOR CHAMBER,
REMOVAL, IMPLANTED MATERIAL, ANTERIOR SEGMENT, EYE
REMOVAL, BLOOD CLOT, ANTERIOR SEGMENT, EYE
INJECTION, ANTERIOR CHAMBER, EYE (SEP PROC); AIR/L
INJECTION, ANTERIOR CHAMBER, EYE (SEP PROC); MEDIC
EXCISION, LESION, SCLERA
FISTULIZATION, SCLERA, GLAUCOMA; TREPHINATION W/IR
FISTULIZATION, SCLERA, GLAUCOMA; THERMOCAUTERIZATI
FISTULIZATION, SCLERA, GLAUCOMA; SCLERECTOMY W/PUN
FISTULIZATION, SCLERA, GLAUCOMA; TRABECULECTOMY AB
FISTULIZATION, SCLERA, GLAUCOMA; TRABECULECTOMY AB
TRLUML DILAT AQUEOUS CANAL W/O DEV/STNT
TRLUML DILAT AQUEOUS CANAL W/DEV/STNT
AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT
AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT
INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR
REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT
REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/GRAFT
REPAIR, SCLERAL STAPHYLOMA; W/O GRAFT
REPAIR, SCLERAL STAPHYLOMA; W/GRAFT
REVISION/REPAIR, OPERATIVE WOUND, ANTERIOR SEGMENT
IRIDOTOMY, STAB INCISION (SEP PROC); EXCEPT TRANSF
IRIDOTOMY, STAB INCISION (SEP PROC); W/TRANSFIXION
IRIDECTOMY, W/CORNEOSCLERAL/CORNEAL SECTION; REMOV
IRIDECTOMY, W/CORNEOSCLERAL/CORNEAL SECTION; W/CYC
IRIDECTOMY, W/CORNEOSCLERAL/CORNEAL SECTION; PERIP
IRIDECTOMY, W/CORNEOSCLERAL/CORNEAL SECTION; SECTO
IRIDECTOMY, W/CORNEOSCLERAL/CORNEAL SECTION; OPTIC
REPAIR, IRIS, CILIARY BODY (AS, IRIDODIALYSIS)
SUTURE, IRIS, CILIARY BODY (SEP PROC) W/SUTURE RET
CILIARY BODY DESTRUCTION; DIATHERMY
CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION
DESTRUCTION, CILIARY BODY
CILIARY BODY DESTRUCTION; CRYOTHERAPY
CILIARY BODY DESTRUCTION; CYCLODIALYSIS
IRIDOTOMY/IRDEC LASER SURG PER SESSION
IRIDOPLASTY, PHOTOCOAGULATION (OVER 1 SESSIONS)
DESTRUCTION, CYST/LESION IRIS/CILIARY BODY (NONEXC
DISCISSION, SECONDARY MEMBRANOUS CATARACT; STAB IN
DISCISSION, SECONDARY MEMBRANOUS CATARACT; LASER (
REPOSITIONING, INTRAOCULAR LENS PROSTHESIS, REQUIR
REMOVAL, SECONDARY MEMBRANOUS CATARACT W/CORNEO-SC
REMOVAL, LENS MATERIAL; ASPIRATION TECHNIQUE, OVER
REMOVAL, LENS MATERIAL; PHACOFRAGMENTATION, W/ASPI
REMOVAL, LENS MATERIAL; PARS PLANA APPROACH, W/WO
REMOVAL, LENS MATERIAL; INTRACAPSULAR
REMOVAL, LENS MATERIAL; INTRACAPSULAR, DISLOCATED
REMOVAL, LENS MATERIAL; EXTRACAPSULAR (OTHER THAN
EXTRACAPSULAR CATARACT REMOVAL W/INSERTION, LENS P
INTRACAPSULAR CATARACT EXTRACTION W/INSERTION, LEN
EXTRACAPSULAR CATARACT REMOVAL W/INSERTION, LENS P
INSERTION, INTRAOCULAR LENS PROSTHESIS (SECONDARY
EXCHANGE, INTRAOCULAR LENS
OPHTHALMIC ENDOSCOPE USE
UNLISTED PROC, ANTERIOR SEGMENT, EYE
REMOVAL, VITREOUS, ANTERIOR APPROACH; PARTIAL REMO
REMOVAL, VITREOUS, ANTERIOR APPROACH; SUBTOTAL REM
ASPIRATION/RELEASE, VITREOUS/SUBRETINAL/CHOROIDAL
INJECTION, VITREOUS SUBSTITUTE, PARS PLANA/LIMBAL
IMPLANT, INTRAVITREAL DRUG DELIVERY SYSTEM W/REMOV
INTRAVITREAL INJECTION, A PHARMACOLOGIC AGENT (SEP
DISCISSION, VITREOUS STRANDS (W/O REMOVAL), PARS P
SEVERING, VITREOUS STRANDS/FACE ADHESIONS/SHEETS/M
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; W/FOC
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; W/END
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2015
1/1/2004
1/1/2014
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
67041
67042
67043
67101
67105
67107
67108
67110
67112
67113
67115
67120
67121
67141
67145
67208
67210
67218
67220
67221
67225
67227
67228
67229
67250
67255
67299
67311
67312
67314
67316
67318
67320
67331
67332
67334
67335
67340
67343
67345
67346
67399
67400
67405
67412
67413
67414
67415
67420
67430
67440
67445
67450
67500
67505
67515
67550
67560
67570
67599
67700
67710
67715
67800
67801
67805
67808
67810
67820
67825
67830
67835
67840
67850
67875
67880
67882
67900
67901
67902
67903
67904
67906
67908
67909
67911
67912
67914
67915
67916
67917
VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE
VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA
VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE
REPAIR, RETINAL DETACHMENT, 1PLUS SESSIONS; CRYOTH
REPAIR, RETINAL DETACHMENT, 1PLUS SESSIONS; PHOTOC
REPAIR, RETINAL DETACHMENT; SCLERAL BUCKLING, W/WO
REPAIR, RETINAL DETACHMENT; W/VITRECTOMY, ANY METH
REPAIR, RETINAL DETACHMENT; INJECTION, AIR/OTHER G
REPAIR, RETINAL DETACHMENT; SCLERAL BUCKLING/VITRE
RPR COMPLEX RETINA DETACH VITRECTOMY & MEMB PEEL
RELEASE, ENCIRCLING MATL (POSTERIOR SEGMENT)
REMOVAL, IMPLANTED MATL, POSTERIOR SEGMENT; EXTRAO
REMOVAL, IMPLANTED MATL, POSTERIOR SEGMENT; INTRAO
PROPHYLAXIS, RETINAL DETACHMENT 1PLUS SESSIONS; CR
PROPHYLAXIS, RETINAL DETACHMENT 1PLUS SESSIONS; PH
DESTRUCTION, LOCALIZED RETINAL LESION, 1PLUS SESSI
DESTRUCTION OF LOCALIZED LESION OF RETINA, 1 OR MO
DESTRUCTION, LOCALIZED RETINAL LESION, 1PLUS SESSI
DESTRUCTION, LOCALIZED LESION, CHOROID; PHOTOCOAGU
DESTRUCTION, LOCALIZED LESION, CHOROID; PHOTODYNAM
DESTRUCTION, LOCALIZED LESION, CHOROID; PHOTODYNAM
DESTRUCTION, EXTENSIVE/PROGRESSIVE RETINOPATHY, 1P
DESTRUCTION, EXTENSIVE/PROGRESSIVE RETINOPATHY, 1P
TRMT EXTENSVE RETINOPATHY 1+ SESS PRETERM-1YR
SCLERAL REINFORCEMENT (SEP PROC); W/O GRAFT
SCLERAL REINFORCEMENT (SEP PROC); W/GRAFT
UNLISTED PROC, POSTERIOR SEGMENT
STRABISMUS SURGERY, RECESSION/RESECTION PROC; 1 HO
STRABISMUS SURGERY, RECESSION/RESECTION PROC; 2 HO
STRABISMUS SURGERY, RECESSION/RESECTION; 1 VERTICA
STRABISMUS SURGERY, RECESSION/RESECTION; 2 PLUS VE
STRABISMUS SURGERY, ANY PROC, SUPERIOR OBLIQUE MUS
TRANSPOSITION PROC, ANY EXTRAOCULAR MUSCLE
STRABISMUS SURGERY, PRIOR EYE SURGERY/INJURY NOT I
STRABISMUS SURGERY, PRIOR SCARRING, EXTRAOCULAR MU
STRABISMUS SURGERY, POSTERIOR FIXATION SUTURE, W/W
PLACEMENT, ADJUSTABLE SUTURES DURING STRABISMUS SU
STRABISMUS SURGERY, EXPLORATION AND/OR REPAIR, DET
RELEASE, EXTENSIVE SCAR TISSUE W/O DETACHING EXTRA
CHEMODENERVATION, EXTRAOCULAR MUSCLE
Biopsy, eye muscle
UNLISTED PROC, OCULAR MUSCLE
ORBITOTOMY W/O BONE FLAP; EXPLORATION, W/WO BX
ORBITOTOMY W/O BONE FLAP; W/DRAINAGE ONLY
ORBITOTOMY W/O BONE FLAP; W/REMOVAL, LESION
ORBITOTOMY W/O BONE FLAP; W/REMOVAL, FB
ORBITOTOMY W/O BONE FLAP; W/REMOVAL, BONE, DECOMPR
FINE NEEDLE ASPIRATION, ORBITAL CONTENTS
ORBITOTOMY W/BONE FLAP/WINDOW, LATERAL APPROACH; W
ORBITOTOMY W/BONE FLAP/WINDOW, LATERAL APPROACH; W
ORBITOTOMY W/BONE FLAP/WINDOW, LATERAL APPROACH; W
ORBITOTOMY W/BONE FLAP/WINDOW, LATERAL APPROACH; W
ORBITOTOMY W/BONE FLAP/WINDOW, LATERAL APPROACH; E
RETROBULBAR INJECTION; MEDICATION (SEP PROC, MEDIC
RETROBULBAR INJECTION; ALCOHOL
INJECTION, THERAPEUTIC AGENT INTO TENONS CAPSULE
ORBITAL IMPLANT (OUTSIDE MUSCLE CONE); INSERTION
ORBITAL IMPLANT (OUTSIDE MUSCLE CONE); REMOVAL/REV
OPTIC NERVE DECOMPRESSION
UNLISTED PROC, ORBIT
BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID
SEVERING, TARSORRHAPHY
CANTHOTOMY (SEP PROC)
EXCISION, CHALAZION; SINGLE
EXCISION OF CHALAZION; MULTIPLE, SAME LID
EXCISION OF CHALAZION; MULTIPLE, DIFF LIDS
EXCISION, CHALAZION; W/ANESTHESIA/HOSPITALIZATION,
INCISIONAL BIOPSY EYELID SKIN & LID MARGIN
CORRECTION, TRICHIASIS; EPILATION, FORCEPS ONLY
CORRECTION, TRICHIASIS; EPILATION, NON-FORCEPS
CORRECTION, TRICHIASIS; INCISION, LID MARGIN
CORRECTION, TRICHIASIS; INCISION, LID MARGIN, W/FR
EXCISION, LESION, EYELID (EXCEPT CHALAZION) W/O CL
DESTRUCTION OF LESION OF LID MARGIN (UP TO 1 CM)
TEMPORARY CLOSURE, EYELIDS, SUTURE
CONSTRUCTION, INTERMARGINAL ADHESIONS, MEDIAN TARS
CONSTRUCTION, INTERMARGINAL ADHESIONS/MEDIAN TARSO
REPAIR, BROW PTOSIS, (SUPRACILIARY/MID-FOREHEAD/CO
REPAIR, BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE
REPAIR, BLEPHAROPTOSIS; FRONTALIS MUSCLE W/FASCIAL
REPAIR, BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION/
REPAIR, BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION/
REPAIR, BLEPHAROPTOSIS; SUPERIOR RECTUS W/FASCIAL
REPAIR, BLEPHAROPTOSIS; CONJUNCTIVO-TARSO-MULLERS
REDUCTION, OVERCORRECTION, PTOSIS
CORRECTION, LID RETRACTION
CORRECTION, LAGOPHTHALMOS, W/IMPLANT, UPPER EYELID
REPAIR, ECTROPION; SUTURE
REPAIR, ECTROPION; THERMOCAUTERIZATION
REPAIR, ECTROPION; EXCISION TARSAL WEDGE
REPAIR, ECTROPION; EXTENSIVE
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
67921
67922
67923
67924
67930
67935
67938
67950
67961
67966
67971
67973
67974
67975
67999
68020
68040
68100
68110
68115
68130
68135
68200
68320
68325
68326
68328
68330
68335
68340
68360
68362
68371
68399
68400
68420
68440
68500
68505
68510
68520
68525
68530
68540
68550
68700
68705
68720
68745
68750
68760
68761
68770
68801
68810
68811
68815
68816
68840
68850
68899
69000
69005
69020
69090
69100
69105
69110
69120
69140
69145
69150
69155
69200
69205
69209
69210
69220
69222
69300
69310
69320
69399
69420
69421
69424
69433
69436
69440
69450
69501
REPAIR, ENTROPION; SUTURE
REPAIR, ENTROPION; THERMOCAUTERIZATION
REPAIR, ENTROPION; EXCISION TARSAL WEDGE
REPAIR, ENTROPION; EXTENSIVE
SUTURE, RECENT WOUND, EYELID; PARTIAL THICKNESS
SUTURE, RECENT WOUND, EYELID; FULL THICKNESS
REMOVAL, EMBEDDED FB, EYELID
CANTHOPLASTY (RECONSTRUCTION, CANTHUS)
EXCISION/REPAIR, EYELID; UP T0 ONE QUARTER, LID MA
EXCISION/REPAIR, EYELID; OVER ONE QUARTER, LID MAR
RECONSTRUCTION, EYELID, FULL THICKNESS; UP TO TWO
RECONSTRUCTION, EYELID, FULL THICKNESS; TOTAL LID,
RECONSTRUCTION, EYELID, FULL THICKNESS; TOTAL LID,
RECONSTRUCTION, EYELID, FULL THICKNESS; 2ND STAGE
UNLISTED PROC, EYELIDS
INCISION, CONJUNCTIVA, DRAINAGE, CYST
EXPRESSION, CONJUNCTIVAL FOLLICLES
BX, CONJUNCTIVA
EXCISION OF LESION, CONJUNCTIVA; UP TO 1 CM
EXCISION, LESION, CONJUNCTIVA; OVER 1 CM
EXCISION, LESION, CONJUNCTIVA; W/ADJACENT SCLERA
DESTRUCTION, LESION, CONJUNCTIVA
SUBCONJUNCTIVAL INJECTION
CONJUNCTIVOPLASTY; W/CONJUNCTIVAL GRAFT/EXTENSIVE
CONJUNCTIVOPLASTY; W/BUCCAL MUCOUS MEMBRANE GRAFT
CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; W/CO
CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; W/BU
REPAIR, SYMBLEPHARON; CONJUNCTIVOPLASTY, W/O GRAFT
REPAIR, SYMBLEPHARON; W/FREE GRAFT CONJUNCTIVA/BUC
REPAIR, SYMBLEPHARON; DIVISION, SYMBLEPHARON
CONJUNCTIVAL FLAP; BRIDGE/PARTIAL (SEP PROC)
CONJUNCTIVAL FLAP; TOTAL, GUNDERSON THIN FLAP/PURS
HARVESTING CONJUNCTIVAL ALLOGRAFT, LIVING DONOR
UNLISTED PROC, CONJUNCTIVA
INCISION, DRAINAGE, LACRIMAL GLAND
INCISION, DRAINAGE, LACRIMAL SAC (DACRYOCYSTOTOMY/
SNIP INCISION, LACRIMAL PUNCTUM
EXCISION, LACRIMAL GLAND (DACRYOADENECTOMY), EXCEP
EXCISION, LACRIMAL GLAND (DACRYOADENECTOMY), EXCEP
BX, LACRIMAL GLAND
EXCISION, LACRIMAL SAC (DACRYOCYSTECTOMY)
BX, LACRIMAL SAC
REMOVAL OF FOREIGN BODY OR DACRYOLITH, LACRIMAL PA
EXCISION, LACRIMAL GLAND TUMOR; FRONTAL APPROACH
EXCISION, LACRIMAL GLAND TUMOR; INVOLVING OSTEOTOM
PLASTIC REPAIR, CANALICULI
CORRECTION, EVERTED PUNCTUM, CAUTERY
DACRYOCYSTORHINOSTOMY (FISTULIZATION, LACRIMAL SAC
CONJUNCTIVORHINOSTOMY; W/O TUBE
CONJUNCTIVORHINOSTOMY; W/INSERTION, TUBE/STENT
CLOSURE, LACRIMAL PUNCTUM; THERMOCAUTERIZATION/LIG
CLOSURE, LACRIMAL PUNCTUM; PLUG, EACH
CLOSURE, LACRIMAL FISTULA (SEP PROC)
DILATION, LACRIMAL PUNCTUM, W/WO IRRIGATION
PROBING, NASOLACRIMAL DUCT, W/WO IRRIGATION
PROBING, NASOLACRIMAL DUCT, W/WO IRRIGATION; REQUI
PROBING, NASOLACRIMAL DUCT, W/WO IRRIGATION; W/INS
PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION
PROBING, LACRIMAL CANALICULI, W/WO IRRIGATION
INJECTION, CONTRAST MEDIUM, DACRYOCYSTOGRAPHY
UNLISTED PROC, LACRIMAL SYSTEM
DRAINAGE EXT EAR, ABSCESS/HEMATOMA; SIMPLE
DRAINAGE EXT EAR, ABSCESS/HEMATOMA; COMPLICATED
DRAINAGE EXT AUDITORY CANAL, ABSCESS
EAR PIERCING
BX EXT EAR
BX EXT AUDITORY CANAL
EXCISION EXT EAR; PARTIAL, SIMPLE REPAIR
EXCISION EXT EAR; COMPLETE AMPUTATION
EXCISION EXOSTOSIS(ES), EXT AUDITORY CANAL
EXCISION SOFT TISSUE LESION, EXT AUDITORY CANAL
RADICAL EXCISION EXT AUDITORY CANAL LESION; W/O NE
RADICAL EXCISION EXT AUDITORY CANAL LESION; W/NECK
REMOVAL FB, EXT AUDITORY CANAL; W/O GENERAL ANESTH
REMOVAL FB, EXT AUDITORY CANAL; W/GENERAL ANESTHES
REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL
REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE
DEBRIDEMENT, MASTOIDECTOMY CAVITY, COMPLEX (EG, W/
OTOPLASTY, PROTRUDING EAR, W/WO SIZE REDUCTION
RECONSTRUCTION, EXT AUDITORY CANAL (SEP PROC)
RECONSTRUCTION, EXT AUDITORY CANAL, CONGENITAL ATR
UNLISTED PROC, EXT EAR
MYRINGOTOMY W/ASPIRATION AND/OR EUSTACHIAN TUBE IN
MYRINGOTOMY W/ASPIRATION AND/OR EUSTACHIAN TUBE IN
VENTILATING TUBE REMOVAL REQUIRING GENERAL ANESTHE
TYMPANOSTOMY (REQUIRING INSERTION, VENTILATING TUB
TYMPANOSTOMY (REQUIRING INSERTION, VENTILATING TUB
MIDDLE EAR EXPLORATION THROUGH POSTAURICULAR/EAR C
TYMPANOLYSIS, TRANSCANAL
TRANSMASTOID ANTROTOMY (SIMPLE MASTOIDECTOMY)
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
69502
69505
69511
69530
69535
69540
69550
69552
69554
69601
69602
69603
69604
69605
69610
69620
69631
69632
69633
69635
69636
69637
69641
69642
69643
69644
69645
69646
69650
69660
69661
69662
69666
69667
69670
69676
69700
69710
69711
69714
69715
69717
69718
69720
69725
69740
69745
69799
69801
69805
69806
69820
69840
69905
69910
69915
69930
69949
69950
69955
69960
69970
69979
69990
70010
70015
70030
70100
7010F
70110
70120
70130
70134
70140
70150
70160
70170
70190
70200
7020F
70210
70220
70240
70250
7025F
70260
70300
70310
70320
70328
70330
MASTOIDECTOMY; COMPLETE
MASTOIDECTOMY; MODIFIED RADICAL
MASTOIDECTOMY; RADICAL
PETROUS APICECTOMY W/RADICAL MASTOIDECTOMY
RESECTION TEMPORAL BONE, EXT APPROACH
EXCISION AURAL POLYP
EXCISION AURAL GLOMUS TUMOR; TRANSCANAL
EXCISION AURAL GLOMUS TUMOR; TRANSMASTOID
EXCISION AURAL GLOMUS TUMOR; EXTENDED (EXTRATEMPOR
REVISION MASTOIDECTOMY; RESULTING IN COMPLETE MAST
REVISION MASTOIDECTOMY; RESULTING IN MODIFIED RADI
REVISION MASTOIDECTOMY; RESULTING IN RADICAL MASTO
REVISION MASTOIDECTOMY; RESULTING IN TYMPANOPLASTY
REVISION MASTOIDECTOMY; W/APICECTOMY
TYMPANIC MEMBRANE REPAIR, W/WO SITE PREPARATION/PE
MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DO
TYMPANOPLASTY W/O MASTOIDECTOMY INITIAL/REVISION;
TYMPANOPLASTY W/O MASTOIDECTOMY INITIAL/REVISION;
TYMPANOPLASTY W/O MASTOIDECTOMY INITIAL/REVISION;
TYMPANOPLASTY W/ANTROTOMY/MASTOIDOTOMY; W/O OSSICL
TYMPANOPLASTY W/ANTROTOMY/MASTOIDOTOMY; W/OSSICLE
TYMPANOPLASTY W/ANTROTOMY/MASTOIDOTOMY; W/OSSICLE
TYMPANOPLASTY W/MASTOIDECTOMY; W/O OSSICLE RECONST
TYMPANOPLASTY W/MASTOIDECTOMY; W/OSSICLE RECONSTRU
TYMPANOPLASTY W/MASTOIDECTOMY; W/O OSSICLE RECONST
TYMPANOPLASTY W/MASTOIDECTOMY; W/OSSICLE RECONSTRU
TYMPANOPLASTY W/MASTOIDECTOMY; W/O OSSICLE RECONST
TYMPANOPLASTY W/MASTOIDECTOMY; W/OSSICLE RECONSTRU
STAPES MOBILIZATION
STABEDECTOMY/STAPEDOTOMY, W/WO FOREIGN MATL
STABEDECTOMY/STAPEDOTOMY, W/WO FOREIGN MATL; W/FOO
REVISION, STAPEDECTOMY/STAPEDOTOMY
REPAIR OVAL WINDOW FISTULA
REPAIR ROUND WINDOW FISTULA
MASTOID OBLITERATION (SEP PROC)
TYMPANIC NEURECTOMY
CLOSURE POSTAURICULAR FISTULA, MASTOID (SEP PROC)
IMPLANTATION/REPLACEMENT, ELECTROMAGNETIC BONE CON
REMOVAL/REPAIR, ELECTROMAGNETIC BONE CONDUCTION HE
IMPLANTATION, OSSEOINTEGRATED IMPLANT TEMPORAL BON
IMPLANTATION, OSSEOINTEGRATED IMPLANT, TEMPORAL BO
REPLACEMENT, OSSEOINTEGRATED IMPLANT, TEMPORAL BON
REPLACEMENT, OSSEOINTEGRATED IMPLANT, TEMPORAL BON
DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; LATERAL
DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; W/MEDIA
SUTURE FACIAL NERVE, INTRATEMPORAL; LATERAL TO GEN
SUTURE FACIAL NERVE, INTRATEMPORAL; MEDIAL TO GENI
UNLISTED PROC, MIDDLE EAR
LABYRINTHOTOMY TRANSCANAL
ENDOLYMPHATIC SAC OPERATION; W/O SHUNT
ENDOLYMPHATIC SAC OPERATION; W/SHUNT
FENESTRATION SEMICIRCULAR CANAL
REVISION FENESTRATION OPERATION
LABYRINTHECTOMY; TRANSCANAL
LABYRINTHECTOMY; W/MASTOIDECTOMY
VESTIBULAR NERVE SECTION, TRANSLABYRINTHINE APPROA
COCHLEAR DEVICE IMPLANTATION, W/WO MASTOIDECTOMY
UNLISTED PROC, INNER EAR
VESTIBULAR NERVE SECTION, TRANSCRANIAL APPROACH
TOTAL FACIAL NERVE DECOMPRESSION AND/OR REPAIR, (M
DECOMPRESSION INT AUDITORY CANAL
REMOVAL, TUMOR, TEMPORAL BONE
UNLISTED PROC, TEMPORAL BONE, MIDDLE FOSSA APPROAC
MICROSURGICAL TECHNIQUES, REQUIRING USE OF OPERATI
MYELOGRAPHY, POSTERIOR FOSSA, RADIOLOGICAL S AND I
CISTERNOGRAPHY, POSITIVE CONTRAST, RADIOLOGICAL S
RADIOLOGIC EXAM, EYE, DETECTION, FB
RADIOLOGIC EXAM, MANDIBLE; PARTIAL, LESS THAN4 VIE
PT INFO INTO RECALL SYSTEM
RADIOLOGIC EXAM, MANDIBLE; COMPLETE, MINIMUM, 4 VI
RADIOLOGIC EXAM, MASTOIDS; LESS THAN 3 VIEWS PER S
RADIOLOGIC EXAM, MASTOIDS; COMPLETE, MINIMUM, 3 VI
RADIOLOGIC EXAM, INT AUDITORY MEATI, COMPLETE
RADIOLOGIC EXAM, FACIAL BONES; LESS THAN 3 VIEWS
RADIOLOGIC EXAM, FACIAL BONES; COMPLETE, MINIMUM,
RADIOLOGIC EXAM, NASAL BONES, COMPLETE, MINIMUM, 3
DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT, RADIOLOGICAL
RADIOLOGIC EXAM; OPTIC FORAMINA
RADIOLOGIC EXAM; ORBITS, COMPLETE, MINIMUM, 4 VIEW
MAMMO ASSESSMENT CAT IN DATABASE FOR RATE
RADIOLOGIC EXAM, SINUSES, PARANASAL, LESS THAN3 VI
RADIOLOGIC EXAM, SINUSES, PARANASAL, COMPLETE, MIN
RADIOLOGIC EXAM, SELLA TURCICA
RADIOLOGIC EXAM, SKULL; LESS THAN 4 VIEWS
PT INFOSYS ALARM 4 NXT MAMMO
RADIOLOGIC EXAM, SKULL; COMPLETE, MINIMUM 4 VIEWS
RADIOLOGIC EXAM, TEETH; SINGLE VIEW
RADIOLOGIC EXAM, TEETH; PARTIAL EXAM, LESS THAN FU
RADIOLOGIC EXAM, TEETH; COMPLETE, FULL MOUTH
RADIOLOGIC EXAM, TEMPOROMANDIBULAR JOINT, OPEN AND
RADIOLOGIC EXAM, TEMPOROMANDIBULAR JOINT, OPEN AND
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
70332
70336
70350
70355
70360
70370
70371
70373
70380
70390
70450
70460
70470
70480
70481
70482
70486
70487
70488
70490
70491
70492
70496
70498
70540
70542
70543
70544
70545
70546
70547
70548
70549
70551
70552
70553
70554
70555
70557
70558
70559
71010
71015
71020
71021
71022
71023
71030
71034
71035
71100
71101
71110
71111
71120
71130
71250
71260
71270
71275
71550
71551
71552
71555
72010
72020
72040
72050
72052
72069
72070
72072
72074
72080
72081
72082
72083
72084
72090
72100
72110
72114
72120
72125
72126
72127
72128
72129
72130
72131
72132
TEMPOROMANDIBULAR JOINT ARTHROGRAPHY, RADIOLOGICAL
MRI, TEMPOROMANDIBULAR JOINTS
CEPHALOGRAM, ORTHODONTIC
ORTHOPANTOGRAM
RADIOLOGIC EXAM; NECK, SOFT TISSUE
RADIOLOGIC EXAM; PHARYNX/LARYNX, W/FLUOROSCOPY AND
COMPLEX DYNAMIC PHARYNGEAL AND SPEECH EVALUATION,
LARYNGOGRAPHY, CONTRAST, RADIOLOGICAL S AND I
RADIOLOGIC EXAM, SALIVARY GLAND, CALCULUS
SIALOGRAPHY, RADIOLOGICAL S AND I
CT SCAN, HEAD/BRAIN; W/O CONTRAST MATL
CT SCAN, HEAD/BRAIN; W/CONTRAST MATL(S)
CT SCAN, HEAD/BRAIN; W/O CONTRAST MATL, THEN W/CON
CT SCAN, ORBIT/SELLA/POSTERIOR FOSSA/OUTER, MIDDLE
CT SCAN, ORBIT/SELLA/POSTERIOR FOSSA/OUTER, MIDDLE
CT SCAN, ORBIT/SELLA/POSTERIOR FOSSA/OUTER, MIDDLE
CT SCAN, MAXILLOFACIAL AREA; W/O CONTRAST MATL
CT SCAN, MAXILLOFACIAL AREA; W/CONTRAST MATL(S)
CT SCAN, MAXILLOFACIAL AREA; W/O CONTRAST MATL, TH
CT SCAN, SOFT TISSUE NECK; W/O CONTRAST MATL
CT SCAN, SOFT TISSUE NECK; W/CONTRAST MATL(S)
CT SCAN, NECK TISSUE; W/O CONTRAST MATL, THEN W/CO
CT ANGIOGRAPHY, HEAD, W/O CONTRAST MATL(S), FOLLOW
CT ANGIOGRAPHY, NECK, W/O CONTRAST MATL(S), FOLLOW
MRI, ORBIT, FACE, AND NECK; W/O CONTRAST MATL(S)
MRI, ORBIT, FACE, AND NECK; W/CONTRAST MATL(S)
MRI, ORBIT, FACE, AND NECK; W/O CONTRAST MATL(S),
MRA, HEAD; W/O CONTRAST MATL(S)
MRA, HEAD; W/CONTRAST MATL(S)
MRA, HEAD; W/O CONTRAST MATL(S), FOLLOWED BY CONTR
MRA, NECK; W/O CONTRAST MATL(S)
MRA, NECK; W/CONTRAST MATL(S)
MRA, NECK; W/O CONTRAST MATL(S), FOLLOWED BY CONTR
MRI, BRAIN; W/O CONTRAST MATL
MRI, BRAIN; W/CONTRAST MATL (S)
MRI, BRAIN; W/O CONTRAST MATL, THEN W/CONTRASTMATL
Fmri brain by tech
Fmri brain by phys/psych
MRI, BRAIN, DURING INTRACRANIAL PROCEDURE; W/O CON
MRI, BRAIN, DURING INTRACRANIAL PROCEDURE; W/ CONT
MRI, BRAIN, DURING INTRACRANIAL PROC; W/O CONTRST
RADIOLOGIC EXAM, CHEST; SINGLE VIEW, FRONTAL
RADIOLOGIC EXAM, CHEST; STEREO, FRONTAL
RADIOLOGIC EXAM, CHEST, 2 VIEWS, FRONTAL AND LATER
RADIOLOGIC EXAM, CHEST, 2 VIEWS, FRONTAL AND LATER
RADIOLOGIC EXAM, CHEST, 2 VIEWS, FRONTAL AND LATER
RADIOLOGIC EXAM, CHEST, 2 VIEWS, FRONTAL AND LATER
RADIOLOGIC EXAM, CHEST, COMPLETE, MINIMUM, 4 VIEWS
RADIOLOGIC EXAM, CHEST, COMPLETE, MINIMUM, 4 VIEWS
RADIOLOGIC EXAM, CHEST, SPECIAL VIEWS
RADIOLOGIC EXAM, RIBS, UNILAT; 2 VIEWS
RADIOLOGIC EXAM, RIBS, UNILAT; W/POSTEROANTERIOR C
RADIOLOGIC EXAM, RIBS, BILAT; 3 VIEWS
RADIOLOGIC EXAM, RIBS, BILAT; W/POSTEROANTERIOR CH
RADIOLOGIC EXAM; STERNUM, 2 PLUS VIEWS
RADIOLOGIC EXAM; STERNOCLAVICULAR JOINT/JOINTS, 3
CT SCAN, THORAX; W/O CONTRAST MATL
CT SCAN, THORAX; W/CONTRAST MATL(S)
CT SCAN, THORAX; W/O CONTRAST MATL, THEN W/CONTRAS
CT ANGIOGRAPHY, CHEST, W/O CONTRAST MATL(S), FOLLO
MRI, CHEST; W/O CONTRAST MATL(S)
MRI, CHEST; W/CONTRAST MATL(S)
MRI, CHEST; W/O CONTRAST MATL(S), FOLLOWED BY CONT
MRA, CHEST (EXCLUDE MYOCARDIUM), W/WO CONTRAST MAT
RADIOLOGIC EXAM, SPINE, ENTIRE, SURVEY STUDY, ANTE
RADIOLOGIC EXAM, SPINE, SINGLE VIEW, SPECIFY LEVEL
RADEX SPINE CERVICAL 2 OR 3 VIEWS
RADEX SPINE CERVICAL 4 OR 5 VIEWS
RADEX SPINE CERVICAL 6 OR MORE VIEWS
RADIOLOGIC EXAM, SPINE, THORACOLUMBAR, STANDING (S
RADIOLOGIC EXAM, SPINE; THORACIC, 2 VIEWS
RADIOLOGIC EXAM, SPINE; THORACIC, 3 VIEWS
RADIOLOGIC EXAM, SPINE; THORACIC, OVER 4 VIEWS
RADIOLOGIC EXAM, SPINE; THORACOLUMBAR, 2 VIEWS
RADIOLOGIC EXAMINATION, SPINE, ENTIRE THORACIC AND LUMBAR, INCLUDING SKULL, CERV
RADIOLOGIC EXAMINATION, SPINE, ENTIRE THORACIC AND LUMBAR, INCLUDING SKULL, CERV
RADIOLOGIC EXAMINATION, SPINE, ENTIRE THORACIC AND LUMBAR, INCLUDING SKULL, CERV
RADIOLOGIC EXAMINATION, SPINE, ENTIRE THORACIC AND LUMBAR, INCLUDING SKULL, CERV
RADIOLOGIC EXAM, SPINE; SCOLIOSIS STUDY, W/SUPINE
RADIOLOGIC EXAM, SPINE, LUMBOSACRAL; 2 OR 3 VIEWS
RADIOLOGIC EXAM, SPINE, LUMBOSACRAL; OVER 4 VIEWS
RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
CT SCAN, CERVICAL SPINE; W/O CONTRAST MATL
CT SCAN, CERVICAL SPINE; W/CONTRAST MATL
CT SCAN, CERVICAL SPINE; W/O CONTRAST MATL, THEN W
CT SCAN, THORACIC SPINE; W/O CONTRAST MATL
CT SCAN, THORACIC SPINE; W/CONTRAST MATL
CT SCAN, THORACIC SPINE; W/O CONTRAST MATL, THEN W
CT SCAN, LUMBAR SPINE; W/O CONTRAST MATL
CT SCAN, LUMBAR SPINE; W/CONTRAST MATL
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1/1/2004
1/1/2004
1/1/2004
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1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
N
Y
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
72133
72141
72142
72146
72147
72148
72149
72156
72157
72158
72159
72170
72190
72191
72192
72193
72194
72195
72196
72197
72198
72200
72202
72220
72240
72255
72265
72270
72275
72285
72295
73000
73010
73020
73030
73040
73050
73060
73070
73080
73085
73090
73092
73100
73110
73115
73120
73130
73140
73200
73201
73202
73206
73218
73219
73220
73221
73222
73223
73225
73500
73501
73502
73503
73510
73520
73521
73522
73523
73525
73530
73540
73550
73551
73552
73560
73562
73564
73565
73580
73590
73592
73600
73610
73615
73620
73630
73650
73660
73700
73701
CT SCAN, LUMBAR SPINE; W/O CONTRAST MATL, THEN W/C
MRI, CERVICAL SPINE; W/O CONTRAST MATL
MRI, CERVICAL SPINE; W/CONTRAST MATL(S)
MRI, THORACIC SPINE; W/O CONTRAST MATL
MRI, THORACIC SPINE; W/CONTRAST MATL(S)
MRI, LUMBAR SPINE; W/O CONTRAST MATL
MRI, LUMBAR SPINE; W/CONTRAST MATL(S)
MRI, SPINE W/O CONTRAST MATL, THEN W/CONTRAST MATL
MRI, SPINE W/O CONTRAST MATL, THEN W/CONTRAST MATL
MRI, SPINE W/O CONTRAST MATL, THEN W/CONTRAST MATL
MRA, SPINE W/WO CONTRAST MATL(S)
RADIOLOGIC EXAM, PELVIS; 1 OR 2 VIEWS
RADIOLOGIC EXAM, PELVIS; COMPLETE, OVER 3 VIEWS
CT ANGIOGRAPHY, PELVIS, W/O CONTRAST MATL(S), FOLL
CT SCAN, PELVIS; W/O CONTRAST MATL
CT SCAN, PELVIS; W/CONTRAST MATL(S)
CT SCAN, PELVIS; W/O CONTRAST MATL, THEN W/CONTRAS
MRI, PELVIS; W/O CONTRAST MATL(S)
MRI, PELVIS; W/CONTRAST MATL(S)
MRI, PELVIS; W/O CONTRAST MATL(S), FOLLOWED BY CON
MRA, PELVIS, W/WO CONTRAST MATL
RADIOLOGIC EXAM, SACROILIAC JOINTS; LESS THAN 3 VI
RADIOLOGIC EXAM, SACROILIAC JOINTS; OVER 3 VIEWS
RADIOLOGIC EXAM, SACRUM AND COCCYX, OVER 2 VIEWS
MYELOGRAPHY, CERVICAL, RADIOLOGICAL S AND I
MYELOGRAPHY, THORACIC, RADIOLOGICAL S AND I
MYELOGRAPHY, LUMBOSACRAL, RADIOLOGICAL S AND I
MYELOGRAPHY, 2 OR MORE REGIONS, RADIOLOGICAL S AND
EPIDUROGRAPHY, RADIOLOGICAL S AND I
DISKOGRAPHY, CERVICAL/THORACIC, RADIOLOGICAL S AND
DISKOGRAPHY, LUMBAR, RADIOLOGICAL S AND I
RADIOLOGIC EXAM; CLAVICLE, COMPLETE
RADIOLOGIC EXAM; SCAPULA, COMPLETE
RADIOLOGIC EXAM, SHOULDER; 1 VIEW
RADIOLOGIC EXAM, SHOULDER; COMPLETE, 2 OR MORE VIE
RADIOLOGIC EXAM, SHOULDER, ARTHROGRAPHY, RADIOLOGI
RADIOLOGIC EXAM; ACROMIOCLAVICULAR JOINTS, BILAT W
RADIOLOGIC EXAM; HUMERUS, OVER 2 VIEWS
RADIOLOGIC EXAM, ELBOW; 2 VIEWS
RADIOLOGIC EXAM, ELBOW; COMPLETE, OVER 3 VIEWS
RADIOLOGIC EXAM, ELBOW, ARTHROGRAPHY, RADIOLOGICAL
RADIOLOGIC EXAM; FOREARM, 2 VIEWS
RADIOLOGIC EXAM; UPPER EXTREMITY, INFANT, OVER 2 V
RADIOLOGIC EXAM, WRIST; 2 VIEWS
RADIOLOGIC EXAM, WRIST; COMPLETE, OVER 3 VIEWS
RADIOLOGIC EXAM, WRIST, ARTHROGRAPHY, RADIOLOGICAL
RADIOLOGIC EXAM, HAND; 2 VIEWS
RADIOLOGIC EXAM, HAND; OVER 3 VIEWS
RADIOLOGIC EXAM, FINGER(S), OVER 2 VIEWS
CT SCAN, UPPER EXTREMITY; W/O CONTRAST MATL
CT SCAN, UPPER EXTREMITY; W/CONTRAST MATL(S)
CT SCAN, UPPER EXTREMITY; W/O CONTRAST MATL, THEN
CT ANGIOGRAPHY, UPPR EXTREM, W/O CONTRAST MATL(S),
MRI, UPPER EXTREMITY, OTHER THAN JOINT; W/O CONTRA
MRI, UPPER EXTREMITY, OTHER THAN JOINT; W/CONTRAST
MRI, UPPER EXTREMITY, OTHER THAN JOINT; W/O CONTRA
MRI, ANY JOINT, UPPER EXTREMITY; W/O CONTRAST MATL
MRI, ANY JOINT, UPPER EXTREMITY; W/CONTRAST MATL(S
MRI, ANY JOINT OF UPPER EXTREMITY; W/O CONTRAST MA
MRA, UPPER EXTREMITY, W/WO CONTRAST MATL(S)
RADIOLOGIC EXAM, HIP, UNILAT; 1 VIEW
RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED; 1 VIEW
RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED; 2-3 VIEWS
RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED; MINIMUM O
RADIOLOGIC EXAM, HIP, UNILAT; COMPLETE, 2 OR MORE
RADIOLOGIC EXAM, HIPS, BILAT, 2 OR MORE VIEWS, W/A
RADIOLOGIC EXAMINATION, HIPS, BILATERAL, WITH PELVIS WHEN PERFORMED; 2 VIEWS
RADIOLOGIC EXAMINATION, HIPS, BILATERAL, WITH PELVIS WHEN PERFORMED; 3-4 VIEWS
RADIOLOGIC EXAMINATION, HIPS, BILATERAL, WITH PELVIS WHEN PERFORMED; MINIMUM OF
RADIOLOGIC EXAM, HIP, ARTHROGRAPHY, RADIOLOGICAL S
RADIOLOGIC EXAM, HIP, DURING OPERATIVE PROC
RADIOLOGIC EXAM, PELVIS AND HIPS, INFANT/CHILD, OV
RADIOLOGIC EXAM, FEMUR, 2 VIEWS
RADIOLOGIC EXAMINATION, FEMUR; 1 VIEW
RADIOLOGIC EXAMINATION, FEMUR; MINIMUM 2 VIEWS
RADIOLOGIC EXAM, KNEE; 1/2 VIEWS
RADIOLOGIC EXAM, KNEE; 3 VIEWS
RADIOLOGIC EXAM, KNEE; COMPLETE, OVER 4 VIEWS
RADIOLOGIC EXAM, KNEE; BOTH KNEES, STANDING, ANTER
RADIOLOGIC EXAM, KNEE, ARTHROGRAPHY, RADIOLOGICAL
RADIOLOGIC EXAM; TIBIA AND FIBULA, TWO VIEWS
RADIOLOGIC EXAM; LOWER EXTREMITY, INFANT, OVER 2 V
RADIOLOGIC EXAM, ANKLE; 2 VIEWS
RADIOLOGIC EXAM, ANKLE; COMPLETE, OVER 3 VIEWS
RADIOLOGIC EXAM, ANKLE, ARTHROGRAPHY, RADIOLOGICAL
RADIOLOGIC EXAM, FOOT; 2 VIEWS
RADIOLOGIC EXAM, FOOT; COMPLETE, OVER 3 VIEWS
RADIOLOGIC EXAM; CALCANEUS, OVER 2 VIEWS
RADIOLOGIC EXAM; TOE(S), OVER 2 VIEWS
CT SCAN, LOWER EXTREMITY; W/O CONTRAST MATL
CT SCAN, LOWER EXTREMITY; W/CONTRAST MATL(S)
1/1/2004
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1/1/2016
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1/1/2016
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1/1/2004
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1/1/2004
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1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
73702
73706
73718
73719
73720
73721
73722
73723
73725
74000
74010
74020
74022
74150
74160
74170
74174
74175
74176
74177
74178
74181
74182
74183
74185
74190
74210
74220
74230
74235
74240
74241
74245
74246
74247
74249
74250
74251
74260
74261
74262
74263
74270
74280
74283
74290
74300
74301
74305
74320
74327
74328
74329
74330
74340
74355
74360
74363
74400
74410
74415
74420
74425
74430
74440
74445
74450
74455
74470
74475
74480
74485
74710
74712
74713
74740
74742
74775
75557
75559
75561
75563
75565
75571
75572
75573
75574
75600
75605
75625
75630
CT SCAN, LOWER EXTREMITY; W/O CONTRAST MATL, THEN
CT ANGIOGRAPHY, LOWER EXTREMITY, W/O CONTRAST MATL
MRI, LOWER EXTREMITY OTHER THAN JOINT; W/O CONTRAS
MRI, LOWER EXTREMITY OTHER THAN JOINT; W/CONTRAST
MRI, LOWER EXTREMITY OTHER THAN JOINT; W/O CONTRAS
MRI, ANY JOINT, LOWER EXTREMITY; W/O CONTRAST MATL
MRI, ANY JOINT, LOWER EXTREMITY; W/CONTRAST MATL(S
MRI, ANY JOINT, LOWER EXTREMITY; W/O CONTRAST MATL
MRA, LOWER EXTREMITY, W/WO CONTRAST MATL(S)
RADIOLOGIC EXAM, ABDOMEN; SINGLE ANTEROPOSTERIOR V
RADIOLOGIC EXAM, ABDOMEN; ANTEROPOSTERIOR AND ADDL
RADIOLOGIC EXAM, ABDOMEN; COMPLETE, W/DECUBITUS AN
RADIOLOGIC EXAMINATION, ABDOMEN; COMPL ACUTE SERIE
CT SCAN, ABDOMEN; W/O CONTRAST MATL
CT SCAN, ABDOMEN; W/CONTRAST MATL(S)
CT SCAN, ABDOMEN; W/O CONTRAST MATL, THEN W/CONTRA
CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES
CT ANGIOGRAPHY, ABDOMEN, W/O CONTRAST MATL(S), FOL
CT ABD & PELVIS W/O CONTRAST
CT ABD & PELVIS W/CONTRAST
CT ABD & PELVIS W/O CONTRST 1+ BODY REGNS
MRI, ABDOMEN; W/O CONTRAST MATL(S)
MRI, ABDOMEN; W/CONTRAST MATL(S)
MRI, ABDOMEN; W/O CONTRAST MATL(S) FOLLOWED BY CON
MRA, ABDOMEN, W/WO CONTRAST MATL(S)
PERITONEOGRAM, RADIOLOGICAL S AND I
RADIOLOGIC EXAM; PHARYNX AND/OR CERVICAL ESOPHAGUS
RADIOLOGIC EXAM; ESOPHAGUS
SWALLOWING FUNCTION, W/CINERADIOGRAPHY AND/OR VIDE
REMOVAL FB, ESOPHAGUS W/BALLOON CATHETER, RADIOLOG
RADIOLOGIC EXAM, UPPER GI TRACT; W/WO DELAYED FILM
RADIOLOGIC EXAM, UPPER GI TRACT; W/WO DELAYED FILM
RADIOLOGIC EXAM, UPPER GI TRACT; W/SMALL INTESTINE
RADIOLOGIC EXAM, UPPER GI TRACT W/CONTRAST W/WO GL
RADIOLOGIC EXAM, UPPER GI TRACT W/CONTRAST W/WO GL
RADIOLOGIC EXAM, UPPER GI TRACT W/CONTRAST W/WO GL
RADIOLOGIC EXAM, SMALL BOWEL, W/MULTIPLE SERIAL FI
RADIOLOGIC EXAM, SMALL BOWEL, W/MULTIPLE SERIAL FI
DUODENOGRAPHY, HYPOTONIC
CT COLONOGRPHY DX IMAGE POSTPROCESS NO CONTRAST
CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST
CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING
RADIOLOGIC EXAM, COLON; BARIUM ENEMA, W/WO KUB
RADIOLOGIC EXAM, COLON; AIR CONTRAST W/SPECIFIC HI
THERAPEUTIC ENEMA, REDUCTION, INTUSSUSCEPTION/OBST
CHOLECYSTOGRAPHY ORAL CONTRST
CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; INTRAOPERA
CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; INTRAOPERA
CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; THROUGH CA
CHOLANGIOGRAPHY, PERCUTANEOUS, TRANSHEPATIC, RADIO
POSTOPERATIVE BILE STONE REMOVAL, PERCUTANEOUS, RA
ENDOSCOPIC CATHETERIZATION, BILE DUCT, RADIOLOGICA
ENDOSCOPIC CATHETERIZATION, PANCREATIC DUCTAL SYST
COMBINED ENDOSCOPIC CATHETERIZATION BILE DUCT AND
INTRODUCTION LONG GI TUBE W/MULTIPLE FLUOROSCOPIES
PERCUTANEOUS PLACEMENT, ENTEROCLYSIS TUBE, RADIOLO
INTRALUMINAL DILATION STRICTURES AND/OR OBSTRUCTIO
PERCUTANEOUS TRANSHEPATIC DILATION, BILE DUCT STRI
UROGRAPHY (PYELOGRAPHY), IV, W/WO KUB, W/WO TOMOGR
UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS T
UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS T
UROGRAPHY, RETROGRADE, W/WO KUB
UROGRAPHY, ANTEGRADE, RADIOLOGICAL S AND I
CYSTOGRAPHY, OVER 3 VIEWS, RADIOLOGICAL S AND I
VASOGRAPHY, VESICULOGRAPHY/EPIDIDYMOGRAPHY, RADIOL
CORPORA CAVERNOSOGRAPHY, RADIOLOGICAL S AND I
URETHROCYSTOGRAPHY, RETROGRADE, RADIOLOGICAL S AND
URETHROCYSTOGRAPHY, VOIDING, RADIOLOGICAL S AND I
RADIOLOGIC EXAM, RENAL CYST STUDY, TRANSLUMBAR, CO
INTRODUCTION CATHETER, RENAL PELVIS, PERCUTANEOUS,
INTRODUCTION URETERAL CATHETER/STENT, PERCUTANEOUS
DILATION, NEPHROSTOMY/URETERS/URETHRA, RADIOLOGICA
PELVIMETRY, W/WO PLACENTAL LOCALIZATION
MAGNETIC RESONANCE (EG, PROTON) IMAGING, FETAL, INCLUDING PLACENTAL AND MATERN
MAGNETIC RESONANCE (EG, PROTON) IMAGING, FETAL, INCLUDING PLACENTAL AND MATERN
HYSTEROSALPINGOGRAPHY, RADIOLOGICAL S AND I
TRANSCERVICAL CATHETERIZATION, FALLOPIAN TUBE, RAD
PERINEOGRAM
CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
CARDIAC MRI W/O CONTRAST W STRESS IMAGING
CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ
CARDIAC MRI W/W/O CONTRAST W STRESS
CARDIAC MRI FOR VELOCITY FLOW MAPPING
CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT DX
CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
AORTOGRAPHY, THORACIC, W/O SERIALOGRAPHY, RADIOLOG
AORTOGRAPHY, THORACIC, SERIALOGRAPHY, RADIOLOGICAL
AORTOGRAPHY, ABDOMINAL, SERIALOGRAPHY, RADIOLOGICA
AORTOGRAPHY, ABDOMINAL AND BILAT ILIOFEMORAL LOWER
1/1/2004
1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
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1/1/2012
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2010
1/1/2010
1/1/2010
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
75635
75658
75705
75710
75716
75724
75726
75731
75733
75736
75741
75743
75746
75756
75774
75791
75801
75803
75805
75807
75809
75810
75820
75822
75825
75827
75831
75833
75840
75842
75860
75870
75872
75880
75885
75887
75889
75891
75893
75894
75896
75898
75901
75902
75945
75946
75952
75953
75954
75956
75957
75958
75959
75962
75964
75966
75968
75970
75978
75980
75982
75984
75989
76000
76001
76010
76080
76098
76100
76101
76102
76120
76125
76140
76376
76377
76380
76390
76496
76497
76498
76499
76506
76510
76511
76512
76513
76514
76516
76519
76529
CT ANGIO, ABD AORTA AND BILAT ILIOFEM LOWR EXTREM
ANGIOGRAPHY, BRACHIAL, RETROGRADE, RADIOLOGICAL S
ANGIOGRAPHY, SPINAL, SELECTIVE, RADIOLOGICAL S AND
ANGIOGRAPHY, EXTREMITY, UNILAT, RADIOLOGICAL S AND
ANGIOGRAPHY, EXTREMITY, BILAT, RADIOLOGICAL S AND
ANGIOGRAPHY, RENAL, BILAT, SELECTIVE, RADIOLOGICAL
ANGIOGRAPHY, VISCERAL, SELECTIVE/SUPRASELECTIVE, R
ANGIOGRAPHY, ADRENAL, UNILAT, SELECTIVE, RADIOLOGI
ANGIOGRAPHY, ADRENAL, BILAT, SELECTIVE, RADIOLOGIC
ANGIOGRAPHY, PELVIC, SELECTIVE/SUPRASELECTIVE, RAD
ANGIOGRAPHY, PULMONARY, UNILAT, SELECTIVE, RADIOLO
ANGIOGRAPHY, PULMONARY, BILAT, SELECTIVE, RADIOLOG
ANGIOGRAPHY, PULMONARY, NON-SELECTIVE CATHETER/VEN
ANGIOGRAPHY, INT MAMMARY, RADIOLOGICAL S AND I
ANGIOGRAPHY, SELECTIVE, ADDL VESSEL(S), RADIOLOGIC
ANGIOGRPHY AV SHUNT COMPLETE EVAL FLUOR S&I
LYMPHANGIOGRAPHY, EXTREMITY ONLY, UNILAT, RADIOLOG
LYMPHANGIOGRAPHY, EXTREMITY ONLY, BILAT, RADIOLOGI
LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, UNILAT, RADIOL
LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, BILAT, RADIOLO
SHUNTOGRAM, INVESTIGATION PREVIOUS NONVASCULAR SHU
SPLENOPORTOGRAPHY, RADIOLOGICAL S AND I
VENOGRAPHY, EXTREMITY, UNILAT, RADIOLOGICAL S AND
VENOGRAPHY, EXTREMITY, BILAT, RADIOLOGICAL S AND I
VENOGRAPHY, CAVAL, INFERIOR, W/SERIALOGRAPHY, RADI
VENOGRAPHY, CAVAL, SUPERIOR, W/SERIALOGRAPHY, RADI
VENOGRAPHY, RENAL, UNILAT, SELECTIVE, RADIOLOGICAL
VENOGRAPHY, RENAL, BILAT, SELECTIVE, RADIOLOGICAL
VENOGRAPHY, ADRENAL, UNILAT, SELECTIVE, RADIOLOGIC
VENOGRAPHY, ADRENAL, BILAT, SELECTIVE, RADIOLOGICA
VENOGRAPHY, SINUS/JUGULAR, CATHETER, RADIOLOGICAL
VENOGRAPHY, SUPERIOR SAGITTAL SINUS, RADIOLOGICAL
VENOGRAPHY, EPIDURAL, RADIOLOGICAL S AND I
VENOGRAPHY, ORBITAL, RADIOLOGICAL S AND I
PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY, W/HEMODYNAM
PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY, W/O HEMODYN
HEPATIC VENOGRAPHY, WEDGE/FREE W/HEMODYNAMIC EVAL
HEPATIC VENOGRAPHY, WEDGE/FREE W/O HEMODYNAMIC EVA
VENOUS SAMPLE, CATHETER, W/WO ANGIOGRAPHY, RADIOLO
TRANSCATHETER THERAPY, EMBOLIZATION, ANY METHOD, R
TRANSCATHETER INFUSION OTHER THAN THROMBOLYSIS
ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS
MECHANICAL REMOVE, PERICATHETER OBSTRUCTIVE MATL F
MECHANICAL REMOVE, INTRALUMINAL OBSTRUCTIVE MATL F
INTRAVASCULAR ULTRASOUND, NON-CORONARY VESSEL, RAD
INTRAVASCULAR ULTRASOUND, NON-CORONARY VESSEL, RAD
ENDOVASCULAR REPAIR, INFRARENAL ABD AORTIC ANEURYS
PLACEMNT, PROX/DISTL EXTEN PROSTHS, ENDVAS REPR, I
EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I
ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA,
ENDOVASCULAR REPAIR OF DESCENDING THORACIC AORTA,
PLACEMENT OF PROXIMAL EXTENSION PROSTHESIS FOR END
PLACEMENT OF DISTAL EXTENSION PROTHESIS (DELAYED)
TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI
TRLUML BALOON ANGIOP PERIPHER EA ADDL ARTERY RSI
TRANSLUMINAL BALLOON ANGIOPLASTY, RENAL/VISCERAL A
TRANSLUMINAL BALLOON ANGIOPLASTY, ADDL VISCERAL AR
TRANSCATHETER BX, RADIOLOGICAL S AND I
TRANSLUMINAL BALLOON ANGIOPLASTY, VENOUS, RADIOLOG
PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE W/CONTR
PERCUTANEOUS BILIARY DRAINAGE, RADIOLOGICAL S AND
PERCUTANEOUS DRAINAGE CATHETER CHANGE, W/CONTRAST,
RADIOLOGICAL GUIDED, PERCUT DRAINAGE, W/CATHETER P
FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME
FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME
RADIOLOGIC EXAM, NOSE TO RECTUM, FB, SINGLE VIEW,
RADIOLOGIC EXAM, ABSCESS/FISTULA/SINUS TRACT, RADI
RADIOLOGICAL EXAM, SURGICAL SPECIMEN
RADIOLOGIC EXAM, SINGLE PLANE BODY SECTION, OTHER
RADIOLOGIC EXAM, COMPLEX MOTION BODY SECTION, NONRADIOLOGIC EXAM, COMPLEX MOTION BODY SECTION, NONCINERADIOGRAPHY/VIDEORADIOLOGY, EXCEPT WHERE SPECI
CINERADIOGRAPHY/VIDEORADIOGRAPHY W/ROUTINE EXAM
CONSULTATION ON X-RAY EXAM MADE ELSEWHERE, WRITTEN
3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
CT SCAN, LIMITED/LOCALIZED FOLLOW-UP STUDY
MR SPECTROSCOPY
UNLISTED FLUOROSCOPIC PROCEDURE
UNLISTED CT PROCEDURE
UNLISTED MR PROCEDURE
UNLISTED DX RADIOGRAPHIC PROCEDURE
ULTRASOUND, HEAD/BRAIN
OPHTHALMIC ULTRASOUND, DIAGNOSITC;B-SCAN AND QUANI
OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DX; A-SCAN ONLY
OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DX; CONTACT B-S
OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DX; ANTERIOR SE
OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DX; CORNEAL PAC
OPHTHALMIC BIOMETRY, ULTRASOUND ECHOGRAPHY, A-SCAN
OPHTHALMIC BIOMETRY, ULTRASOUND ECHOGRAPHY, A-SCAN
OPHTHALMIC ULTRASONIC FB LOCALIZATION
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/1900
1/1/1900
1/1/1900
1/1/1900
1/1/1900
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
Y
N
Y
Y
N
N
N
N
N
N
N
N
N
N
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
76536
76604
76641
76642
76700
76705
76770
76775
76776
76800
76801
76802
76805
76810
76811
76812
76813
76814
76815
76816
76817
76818
76819
76820
76821
76825
76826
76827
76828
76830
76831
76856
76857
76870
76872
76873
76881
76882
76885
76886
76930
76932
76936
76937
76940
76941
76942
76945
76946
76948
76965
76970
76975
76977
76998
76999
77001
77002
77003
77011
77012
77013
77014
77021
77022
77051
77052
77053
77054
77055
77056
77057
77058
77059
77061
77062
77063
77071
77072
77073
77074
77075
77076
77077
77078
77080
77081
77084
77085
77086
77261
ULTRASOUND, HEAD/NECK TISSUES, B-SCAN/REAL TIME W/
ECHOGRAPHY, CHEST, B-SCAN (INCLUDES MEDIASTINUM) A
US BREAST UNI REAL TIME WITH IMAGE COMPLETE
US BREAST UNI REAL TIME WITH IMAGE LIMITED
ULTRASOUND, ABDOMINAL, B-SCAN AND/OR REAL TIME W/I
ULTRASOUND, ABDOMINAL, B-SCAN AND/OR REAL TIME W/I
ULTRASOUND, RETROPERITONEUM, B-SCAN/REAL TIME; COM
ULTRASOUND, RETROPERITONEUM, B-SCAN/REAL TIME; LIM
Us exam k transpl w/doppler
ECHOGRAPHY, SPINAL CANAL AND CONTENTS
US, PREG UTER, REAL TIME W/IMAGE DOCUMENT, FETAL A
US, PREG UTER, REAL TIME W/IMAGE DOCUMENT, FETAL A
US, PREG UTER, RLTIME W/IMAGE DOCUMENT, FETAL AND
US, PREG UTER, REAL TIME W/IMAGE DOCUMENT EA ADDL
US, PREG UTER, REAL TIME W/IMAGE DOC, FETL/MATRNL,
US, PREG UTER, REAL TIME W/IMAGE DOC, FETAL/MATERN
Ob us nuchal meas, 1 gest
Ob us nuchal meas, add-on
US, PREGNANT UTERUS, REAL TIME W/IMAGE DOCUMENT, L
US, PREGNANT UTERUS, REAL TIME W/IMAGE DOCUMENT, F
US, PREGNANT UTERUS, REAL TIME W/IMAGE DOCUMENT, T
FETAL BIOPHYSICAL PROFILE; W/NON-STRESS TESTING
FETAL BIOPHYSICAL PROFILE; W/O NON-STRESS TESTING
DOPPLER VELOCIMETRY, FETAL; UMBILICAL ARTERY
DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY
ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, RE
ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, RE
ECHOCARDIOGRAPHY, FETAL, DOPPLER, CARDIOVASCULAR S
ECHOCARDIOGRAPHY, FETAL, DOPPLER, CARDIOVASCULAR S
ECHOGRAPHY, TRANSVAGINAL
SALINE INFUSION SONOHYSTEROGRAPHY, W/COLOR FLOW DO
ECHOGRAPHY, PELVIC (NONOBSTETRIC), B-SCAN AND/OR R
ECHOGRAPHY, PELVIS, B-SCAN/REAL TIME; LIMITED/FOLL
ECHOGRAPHY, SCROTUM AND CONTENTS
US, TRANSRECTAL
ECHOGRAPHY, TRANSRECTAL; PROSTATE VOLUME STUDY, BR
US EXTREMITY NON-VASC REAL-TIME IMG COMPL
US EXTREMITY NON-VASC REAL-TIME IMG LMTD
US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ
US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ
US GUIDANCE, PERICARDIOCENTESIS, IMAGING S AND I
US GUIDANCE, ENDOMYOCARDIAL BX, IMAGING S AND I
US GUIDANCE, COMPRESSION REPAIR, PSEUDO-ANEURYSM/A
US GUIDE, VASC ACCESS, REQ EVAL, POTENTIAL SITES,
US GUIDANCE, AND MONITORING, VISCERAL TISSUE ABLAT
US GUIDANCE, INTRAUTERINE FETAL TRANSFUSION/CORDOC
US GUIDANCE, NEEDLE PLACEMENT, RADIOLOGICAL S AND
US GUIDANCE, CHORIONIC VILLUS SAMPLING, IMAGING S
US GUIDANCE, AMNIOCENTESIS, IMAGING S AND I
US GUIDANCE, ASPIRATION, OVA, IMAGING S AND I
US GUIDANCE, INTERSTITIAL RADIOELEMENT APPLICATION
US STUDY FOLLOW-UP (SPECIFY)
GI ENDOSCOPIC US, S AND I
US BONE DENSITY MEASUREMENT AND INTERPRETATION, PE
Us guide, intraop
UNLISTED ULTRASOUND PROCEDURE
Fluoroguide for vein device
Needle localization by xray
FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER
Ct scan for localization
Ct scan for needle biopsy
Ct guide for tissue ablation
Ct scan for therapy guide
Mr guidance for needle place
Mri for tissue ablation
COMPUTER-AIDED DETECTION DX MAMMOGRAPHY
COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY
X-ray of mammary duct
X-ray of mammary ducts
Mammogram, one breast
Mammogram, both breasts
Mammogram, screening
Mri, one breast
Mri, both breasts
DIGITAL BREAST TOMOSYNTHESIS UNILATERAL
DIGITAL BREAST TOMOSYNTHESIS BILATERAL
SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS
X-rays for bone age
X-rays, bone length studies
X-rays, bone survey, limited
X-rays, bone survey complete
X-rays, bone survey, infant
Joint survey, single view
Ct bone density, axial
Dxa bone density, axial
Dxa bone density/peripheral
Magnetic image, bone marrow
DXA BONE DENSITY STUDY AXIAL SKELETON
VERTEBRAL FRACTURE ASSESSMENT VIA DXA
THERAPEUTIC RADIOLOGY TREATMENT PLANNING; SIMPLE
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2015
1/1/2015
1/1/2015
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2015
1/1/2015
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
Y
N
N
N
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
77262
77263
77280
77285
77290
77293
77295
77299
77300
77301
77306
77307
77316
77317
77318
77321
77331
77332
77333
77334
77336
77338
77370
77371
77372
77373
77385
77386
77387
77399
77401
77402
77407
77412
77417
77422
77423
77424
77425
77427
77431
77432
77435
77469
77470
77499
77520
77522
77523
77525
77600
77605
77610
77615
77620
77750
77761
77762
77763
77767
77768
77770
77771
77772
77776
77778
77785
77786
77787
77789
77790
77799
78012
78013
78014
78015
78016
78018
78020
78070
78071
78072
78075
78099
78102
78103
78104
78110
78111
78120
78121
THERAPEUTIC RADIOLOGY TREATMENT PLANNING; INTERMED
THERAPEUTIC RADIOLOGY TREATMENT PLANNING; COMPLEX
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTI
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTI
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTI
RESPIRATORY MOTION MANAGEMENT SIMULATION
RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
UNLISTED PROC, THERAPEUTIC RADIOLOGY CLINICAL TREA
RADIATION THERAPY, DOSIMETRY PLAN
INTENSITY MODULATED RADIOTHERAPY PLAN W/DOSE VOLUM
TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL
BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL
BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL
SPECIAL TELETHERAPY PORT PLAN, PARTICLES, HEMIBODY
RADIATION THERAPY, SPECIAL DOSIMETRY
TREATMENT DEVICES, DESIGN AND CONSTRUCTION; SIMPLE
TREATMENT DEVICES, DESIGN AND CONSTRUCTION; INTERM
TREATMENT DEVICES, DESIGN AND CONSTRUCTION; COMPLE
CONTINUING MEDICAL PHYSICS CONSULTATION, PER WEEK
MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
SPECIAL MEDICAL RADIATION PHYSICS CONSULTATION
Srs, multisource
Srs, linear based
Sbrt delivery
INTENSITY MODULATED RADIATION TX DLVR SIMPLE
INTENSITY MODULATED RADIATION TX DLVR COMPLEX
GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR
UNLISTED PROC, RADIATION/PHYSICS/DOSIMETRY AND TRE
RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA
RADIATION TREATMENT DELIVERY 1 MEV+ SIMPLE
RADIATION TREATMENT DELIVERY 1 MEV+ INTERMEDIATE
RADIATION TREATMENT DELIVERY 1 MEV+ COMPLEX
THERAPEUTIC RADIOLOGY PORT FILM(S)
HIGH ENERGY NEUTRON RAD TX DELIVERY; SINGLE TREATM
HIGH ENERGY NEUTRON RAD TX DELIVERY; 1 OR MORE ISO
INTRAOP RADIAJ TX DELIVER XRAY SINGLE TX SESSION
INTRAOP RADIAJ TX DELIVER ELECTRONS SNGL TX SESS
RADIATION TREATMENT MANAGEMENT, 5 TREATMENTS
RADIATION THERAPY MANAGEMENT, COMPLETE, 1 TO 2 FRA
RADIATION TREATMENT MANAGEMENT, STEREOTACTIC, CERE
Sbrt management
INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT
SPECIAL TREATMENT PROC
UNLISTED PROC, THERAPEUTIC RADIOLOGY TREATMENT MAN
PROTON TREATMENT DELIVERY; SIMPLE W/O COMPENSATION
PROTON TREATMENT DELIVERY; SIMPLE W/COMPENSATION
PROTON TREATMENT DELIVERY; INTERMEDIATE
PROTON TREATMENT DELIVERY; COMPLEX
HYPERTHERMIA, EXTERNALLY GENERATED; SUPERFICIAL
HYPERTHERMIA, EXTERNALLY GENERATED; DEEP
HYPERTHERMIA GENERATED, INTERSTITIAL PROBE(S); UP
HYPERTHERMIA GENERATED, INTERSTITIAL PROBE(S); MOR
HYPERTHERMIA GENERATED, INTRACAVITARY PROBE(S)
INFUSION/INSTILLATION, RADIOELEMENT SOLUTION
INTRACAVITARY RADIATION SOURCE APPLICATION; SIMPLE
INTRACAVITARY RADIATION SOURCE APPLICATION; INTERM
INTRACAVITARY RADIATION SOURCE APPLICATION; COMPLE
REMOTE AFTERLOADING HIGH DOSE RATE RADIONUCLIDE SKIN SURFACE BRACHYTHERAPY, IN
REMOTE AFTERLOADING HIGH DOSE RATE RADIONUCLIDE SKIN SURFACE BRACHYTHERAPY, IN
REMOTE AFTERLOADING HIGH DOSE RATE RADIONUCLIDE INTERSTITIAL OR INTRACAVITARY B
REMOTE AFTERLOADING HIGH DOSE RATE RADIONUCLIDE INTERSTITIAL OR INTRACAVITARY B
REMOTE AFTERLOADING HIGH DOSE RATE RADIONUCLIDE INTERSTITIAL OR INTRACAVITARY B
INTERSTITIAL RADIATION SOURCE APPLICATION; SIMPLE
INTERSTITIAL RADIOELEMENT APPLICATION; COMPLEX
REMOTE AFTLD RADIONUCLIDE BRACHYTX 1 CHANNEL
REMOTE AFTLD RADIONUCLIDE BRACHYTX 2-12 CHANNEL
REMOTE AFTLD RADIONUCLIDE BRACHYTX > 12 CHANNEL
SURFACE APPLICATION, RADIATION SOURCE
SUPERVISION, HANDLING, LOADING, RADIATION SOURCE
UNLISTED PROC, CLINICAL BRACHYTHERAPY
THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT
THYROID IMAGING WITH VASCULAR FLOW
THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS
THYROID CARCINOMA METASTASES IMAGING; LIMITED AREA
THYROID CARCINOMA METASTASES IMAGING; W/ADDL STUDI
THYROID CARCINOMA METASTASES IMAGING; WHOLE BODY
THYROID CARCINOMA METASTASES UPTAKE
PARATHYROID PLANAR IMAGING
PARATHYROID PLANAR IMAGING W/WO SUBTRACTION
PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT
ADRENAL IMAGING, CORTEX AND/OR MEDULLA
UNLISTED ENDOCRINE PROC, DX NUCLEAR MEDICINE
BONE MARROW IMAGING; LIMITED AREA
BONE MARROW IMAGING; MULTIPLE AREAS
BONE MARROW IMAGING; WHOLE BODY
PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION
PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION
RED CELL VOLUME DETERMINATION (SEP PROC); SINGLE S
RED CELL VOLUME DETERMINATION (SEP PROC); MULTIPLE
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
78122
78130
78135
78140
78185
78190
78191
78195
78199
78201
78202
78205
78206
78215
78216
78226
78227
78230
78231
78232
78258
78261
78262
78264
78265
78266
78267
78268
78270
78271
78272
78278
78282
78290
78291
78299
78300
78305
78306
78315
78320
78350
78351
78399
78414
78428
78445
78451
78452
78453
78454
78456
78457
78458
78459
78466
78468
78469
78472
78473
78481
78483
78491
78492
78494
78496
78499
78579
78580
78582
78597
78598
78599
78600
78601
78605
78606
78607
78608
78609
78610
78630
78635
78645
78647
78650
78660
78699
78700
78701
78707
WHOLE BLOOD VOLUME DETERMINATION, RADIOPHARMACEUTI
RED CELL SURVIVAL STUDY
RED CELL SURVIVAL STUDY; DIFFERENTIAL ORGAN/TISSUE
LABELED RED CELL SEQUESTRATION, DIFFERENTIAL ORGAN
SPLEEN IMAGING ONLY, W/WO VASCULAR FLOW
KINETICS, STUDY, PLATELET SURVIVAL, W/WO DIFFERENT
PLATELET SURVIVAL STUDY
LYMPHATICS AND LYMPH GLANDS IMAGING
UNLISTED HEMATOPOIETIC/RETICULOENDOTHELIAL/LYMPHAT
LIVER IMAGING; STATIC ONLY
LIVER IMAGING; W/VASCULAR FLOW
LIVER IMAGING (SPECT)
LIVER IMAGING (SPECT); W/VASCULAR FLOW
LIVER AND SPLEEN IMAGING; STATIC ONLY
LIVER AND SPLEEN IMAGING; W/VASCULAR FLOW
HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER
HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ
SALIVARY GLAND IMAGING
SALIVARY GLAND IMAGING; W/SERIAL IMAGES
SALIVARY GLAND FUNCTION STUDY
ESOPHAGEAL MOTILITY
GASTRIC MUCOSA IMAGING
GASTROESOPHAGEAL REFLUX STUDY
GASTRIC EMPTYING STUDY
GASTRIC EMPTYING IMAGING STUDY (EG, SOLID, LIQUID, OR BOTH); WITH SMALL BOWEL TRA
GASTRIC EMPTYING IMAGING STUDY (EG, SOLID, LIQUID, OR BOTH); WITH SMALL BOWEL AND
BREATH TEST, C-14 UREA; ACQUISITION AND ANALYSIS
BREATH TEST, C-14 UREA; ANALYSIS
VITAMIN B-12 ABSORPTION STUDY; W/O INTRINSIC FACTO
VITAMIN B-12 ABSORPTION STUDY; W/INTRINSIC FACTOR
VITAMIN B-12 ABSORPTION STUDIES COMBINED, W/WO INT
ACUTE GI BLOOD LOSS IMAGING
GI PROTEIN LOSS
BOWEL IMAGING
PERITONEAL-VENOUS SHUNT PATENCY TEST
UNLISTED GI PROC, DX NUCLEAR MEDICINE
BONE AND/OR JOINT IMAGING; LIMITED AREA
BONE AND/OR JOINT IMAGING; MULTIPLE AREAS
BONE AND/OR JOINT IMAGING; WHOLE BODY
BONE AND/OR JOINT IMAGING; THREE PHASE STUDY
BONE AND/OR JOINT IMAGING; TOMOGRAPHIC (SPECT)
BONE DENSITY (BONE MINERAL CONTENT) STUDY, 1OR MOR
BONE DENSITY STUDY, 1 OR MORE SITES; DUAL PHOTON
UNLISTED MUSCULOSKELETAL PROC, DX NUCLEAR MEDICINE
DETERMINATION, CENTRAL C-V HEMODYNAMICS, NON-IMAGI
CARDIAC SHUNT DETECTION
NON-CARDIAC VASCULAR FLOW IMAGING
MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
MYOCARDIAL SPECT MULTIPLE STUDIES
MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
IMAGING, PEPTIDE, ACUTE VENOUS THROMBOSIS
VENOUS THROMBOSIS, IMAGING, VENOGRAM; UNILAT
VENOUS THROMBOSIS, IMAGING, VENOGRAM; BILAT
MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (
MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; QUALITAT
MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; W/EJECTI
MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; TOMOGRAP
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; PLA
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; PLA
CARDIAC BLOOD POOL IMAGING, PLANAR, 1ST PASS; SING
CARDIAC BLOOD POOL IMAGING, PLANAR, 1ST PASS; MULT
MYOCARDIAL PET; SINGLE STUDY, REST/STRESS
MYOCARDIAL PET; MULTIPLE STUDIES, REST AND/OR STRE
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, RES
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SIN
UNLISTED CARDIOVASCULAR PROC, DX NUCLEAR MEDICINE
PULMONARY VENTILATION IMAGING
PULMONARY PERFUSION IMAGING PARTICULATE
PULMONARY VENTILATION & PERFUSION IMAGING
QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING
QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGING
UNLISTED RESPIRATORY PROC, DX NUCLEAR MEDICINE
BRAIN IMAGING, LIMITED PROC; STATIC
BRAIN IMAGING, LIMITED PROC; W/VASCULAR FLOW
BRAIN IMAGING, COMPLETE STUDY; STATIC
BRAIN IMAGING, COMPLETE STUDY; W/VASCULAR FLOW
BRAIN IMAGING, COMPLETE STUDY; TOMOGRAPHIC (SPECT)
BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET);
BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET);
BRAIN IMAGING, VASCULAR FLOW ONLY
CEREBROSPINAL FLUID FLOW, IMAGING (NOT W/INTRODUCT
CEREBROSPINAL FLUID FLOW, IMAGING (NOT W/INTRODUCT
CEREBROSPINAL FLUID FLOW, IMAGING (NOT W/INTRODUCT
CEREBROSPINAL FLUID FLOW, IMAGING (NOT W/INTRODUCT
CSF LEAKAGE DETECTION AND LOCALIZATION
RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY
UNLISTED NERVOUS SYSTEM PROC, DX NUCLEAR MEDICINE
KIDNEY IMAGING; STATIC ONLY
KIDNEY IMAGING; W/VASCULAR FLOW
KIDNEY IMAGING W/BLOOD FLOW AND FUNCTION; SINGLE W
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
78708
78709
78710
78725
78730
78740
78761
78799
78800
78801
78802
78803
78804
78805
78806
78807
78808
78811
78812
78813
78814
78815
78816
78999
79005
79101
79200
79300
79403
79440
79445
79999
80047
80048
80050
80051
80053
80055
80061
80069
80074
80076
80081
80150
80155
80156
80157
80158
80159
80162
80163
80164
80165
80168
80169
80170
80171
80173
80175
80176
80177
80178
80180
80183
80184
80185
80186
80188
80190
80192
80194
80195
80197
80198
80199
80200
80201
80202
80203
80299
80300
80301
80302
80303
80304
80320
80321
80322
80323
80324
80325
KIDNEY IMAGING W/BLOOD FLOW AND FUNCTION; SINGLE W
KIDNEY IMAGING W/BLOOD FLOW AND FUNCTION; MULTIPLE
KIDNEY IMAGING, TOMOGRAPHIC (SPECT)
KIDNEY FUNCTION STUDY, NON-IMAGING RADIOISOTOPIC S
URINARY BLADDER RESIDUAL STUDY
URETERAL REFLUX STUDY (RADIOPHARMACEUTICAL VOIDING
TESTICULAR IMAGING; W/VASCULAR FLOW
UNLISTED GENITOURINARY PROC, DX NUCLEAR MEDICINE
RADIOPHARMACEUTICAL LOCALIZATION, TUMOR, AGENT(S)
RADIOPHARMACEUTICAL LOCALIZATION, TUMOR; MULTIPLE
RADIOPHARMACEUTICAL LOCALIZATION, TUMOR; WHOLE BOD
RADIOPHARMACEUTICAL LOCALIZATION, TUMOR; TOMOGRAPH
RADIOPHARMACEUTICAL LOCALIZATION, TUMOR; WHOLE BOD
RADIOPHARMACEUTICAL LOCALIZATION, INFLAMMATORY PRO
RADIOPHARMACEUTICAL LOCALIZATION, ABSCESS; WHOLE B
RADIOPHARMACEUTICAL LOCALIZATION, ABSCESS; TOMOGRA
NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS
TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET),
TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET),
TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET),
TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET)
TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET)
TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET)
UNLISTED MISCELLANEOUS PROC, DX NUCLEAR MEDICINE
RADIOPHARMACEUTICAL THERAPY, BY ORAL ADMINISTRATIO
RADIOPHARMACEUTICAL THERAPY, BY IV ADMINISTRATION
INTRACAVITARY RADIOACTIVE COLLOID THERAPY
INTERSTITIAL RADIOACTIVE COLLOID THERAPY
RADIOPHARMACEUTICAL THERAPY, RADIOLABELED MONOCLON
INTRA-ARTICULAR RADIOPHARMACEUTICAL THERAPY
RADIOPHARMACEUTICAL THERAPY, BY INTRA-ARTERIAL PAR
UNLISTED RADIOPHARMACEUTICAL THERAPEUTIC PROC
BASIC METABOLIC PANEL CALCIUM IONIZED
BASIC METABOLIC PANEL
GENERAL HEALTH PANEL
ELECTROLYTE PANEL
COMPREHENSIVE METABOLIC PANEL
OBSTETRIC PANEL
LIPID PANEL
RENAL FUNCTION PANEL
ACUTE HEPATITIS PANEL
HEPATIC FUNCTION PANEL
OBSTETRIC PANEL (INCLUDES HIV TESTING)
ASSAY OF AMIKACIN
DRUG SCREEN QUANTITATIVE CAFFEINE
ASSAY OF CARBAMAZEPINE; TOTAL
ASSAY OF CARBAMAZEPINE; FREE
ASSAY OF CYCLOSPORINE
DRUG SCREEN QUANTITATIVE CLOZAPINE
DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL
DRUG SCREEN QUANTITATIVE DIGOXIN FREE
DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL
DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE
ASSAY OF ETHOSUXIMIDE
DRUG SCREEN QUANTITATIVE EVEROLIMUS
ASSAY OF GENTAMICIN
DRUG SCREEN QUANTITATIVE GABAPENTIN
ASSAY OF HALOPERIDOL
DRUG SCREEN QUANTITATIVE LAMOTRIGINE
ASSAY OF LIDOCAINE
DRUG SCREEN QUANTITATIVE LEVETIRACETAM
ASSAY OF LITHIUM
DRUG SCREEN QUANTITATIVE MYCOPHENOLATE
DRUG SCREEN QUANTITATIVE OXCARBAZEPINE
ASSAY OF PHENOBARBITAL
ASSAY OF PHENYTOIN; TOTAL
ASSAY OF PHENYTOIN; FREE
ASSAY OF PRIMIDONE
ASSAY OF PROCAINAMIDE
ASSAY OF PROCAINAMIDE; W/METABOLITES
ASSAY OF QUINIDINE
SIROLIMUS
ASSAY OF TACROLIMUS
ASSAY OF THEOPHYLLINE
DRUG SCREEN QUANTITATIVE TIAGABINE
ASSAY OF TOBRAMYCIN
ASSAY OF TOPIRAMATE
ASSAY OF VANCOMYCIN
DRUG SCREEN QUANTITATIVE ZONISAMIDE
QUANTITATION DRUG NOT ELSEWHERE SPECIFIED
DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES
DRUG SCREEN LIST A SINGLE DRUG CLASS METHOD
DRUG SCREEN PRESUMPTIVE 1 CLASS METHOD LIST B
DRUG SCREEN PRSMPTV 1/MULT CLASS METHOD TLC
DRUG SCREEN PRSMPTV 1/MULT CLASS METHOD
DRUG SCREEN QUANTITATIVE ALCOHOLS
DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2
DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 3 OR MORE
ALKALOIDS NOT OTHERWISE SPECIFIED
DRUG SCREEN QUANT AMPHETAMINES 1 OR 2
DRUG SCREEN QUANT AMPHETAMINES 3 OR 4
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2004
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2004
1/1/2015
1/1/2004
1/1/2015
1/1/2004
1/1/2014
1/1/2004
1/1/2014
1/1/2004
1/1/2014
1/1/2004
1/1/2014
1/1/2004
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2004
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
80326
80327
80328
80329
80330
80331
80332
80333
80334
80335
80336
80337
80338
80339
80340
80341
80342
80343
80344
80345
80346
80347
80348
80349
80350
80351
80352
80353
80354
80355
80356
80357
80358
80359
80360
80361
80362
80363
80364
80365
80366
80367
80368
80369
80370
80371
80372
80373
80374
80375
80376
80377
80400
80402
80406
80408
80410
80412
80414
80415
80416
80417
80418
80420
80422
80424
80426
80428
80430
80432
80434
80435
80436
80438
80439
80500
80502
81000
81001
81002
81003
81005
81007
81015
81020
81025
81050
81099
81161
81162
81170
DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE
DRUG SCREEN QUANT ANABOLIC STEROID 1 OR 2
DRUG SCREEN QUANT ANABOLIC STEROID 3 OR MORE
DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2
DRUG SCREEN ANALGESICS NON-OPIOID 3-5
DRUG SCREEN ANALGESICS NON-OPIOID 6 OR MORE
ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2
ANTIDEPRESSANTS SEROTONERGIC CLASS 3-5
ANTIDEPRESSANTS SEROTONERGIC CLASS 6 OR MORE
ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2
ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 3-5
ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE
ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED
ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3
ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 4-6
ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 7/MORE
ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3
ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 4-6
ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 7/MORE
DRUG SCREENING BARBITURATES
DRUG SCREENING BENZODIAZEPINES 1-12
DRUG SCREENING BENZODIAZEPINES 13 OR MORE
DRUG SCREENING BUPRENORPHINE
DRUG SCREENING CANNABINOIDS NATURAL
DRUG SCREENING CANNABINOIDS SYNTHETIC 1-3
DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6
DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE
DRUG SCREENING COCAINE
DRUG SCREENING FENTANYL
DRUG SCREENING GABAPENTIN NON-BLOOD
DRUG SCREENING HEROIN METABOLITE
DRUG SCREENING KETAMINE AND NORKETAMINE
DRUG SCREENING METHADONE
DRUG SCREENING METHYLENEDIOXYAMPHETAMINES
DRUG SCREENING METHYLPHENIDATE
DRUG SCREENING OPIATES 1 OR MORE
DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2
DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 3 OR 4
DRUG SCREENING OPIOIDS & OPIATE ANALOGS 5/MORE
DRUG SCREENING OXYCODONE
DRUG SCREENING PREGABALIN
DRUG SCREENING PROPOXYPHENE
DRUG SCREENING SEDATIVE HYPNOTICS
DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2
DRUG SCREENING SKEL MUSCLE RELAXANTS 3 OR MORE
DRUG SCREENING STIMULANTS SYNTHETIC
DRUG SCREENING TAPENTADOL
DRUG SCREENING TRAMADOL
DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS
DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3
DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 4-6
DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7/MORE
ACTH STIMULATION PANEL; ADRENAL INSUFFICIENCY
ACTH STIMULATION PANEL; 21 HYDROXYLASE DEFICIENCY
ACTH STIMULATION PANEL; 3 BETA-HYDROXYDEHYDROGENAS
ALDOSTERONE SUPPRESSION EVAL PANEL
CALCITONIN STIMULATION PANEL
CORTICOTROPIC RELEASING HORMONE (CRH) STIMULATION
CHORIONIC GONADOTROPIN STIMULATION PANEL; TESTOSTE
CHORIONIC GONADOTROPIN STIMULATION PANEL; ESTRADIO
RENAL VEIN RENIN STIMULATION PANEL
PERIPHERAL VEIN RENIN STIMULATION PANEL
COMBINED RAPID ANTERIOR PITUITARY EVAL PANEL
DEXAMETHASONE SUPPRESSION PANEL, 48 HR
GLUCAGON TOLERANCE PANEL; INSULINOMA
GLUCAGON TOLERANCE PANEL; PHEOCHROMOCYTOMA
GONADOTROPIN RELEASING HORMONE STIMULATION PANEL
GROWTH HORMONE STIMULATION PANEL
GROWTH HORMONE SUPPRESSION PANEL (GLUCOSE ADMINIST
INSULIN-INDUCED C-PEPTIDE SUPPRESSION PANEL
INSULIN TOLERANCE PANEL; ACTH INSUFFICIENCY
INSULIN TOLERANCE PANEL; GROWTH HORMONE DEFICIENCY
METYRAPONE PANEL
TRH STIMULATION PANEL; 1 HR
TRH STIMULATION PANEL; 2 HR
CLINICAL PATHOLOGY CONSULTATION; LIMITED, W/O REVI
CLINICAL PATHOLOGY CONSULTATION; COMPREHENSIVE, W/
URINALYSIS, DIP STICK/TABLET REAGENT; NON-AUTOMATE
URINALYSIS, DIP STICK/TABLET REAGENT; AUTOMATED W/
URINALYSIS, DIP STICK/TABLET REAGENT; NON-AUTOMATE
URINALYSIS, DIP STICK/TABLET REAGENT; AUTOMATED, W
URINALYSIS; QUALITATIVE/SEMIQUANTITATIVE, EXCEPT I
URINALYSIS; BACTERIURIA SCREEN, EXCEPT BY CULTURE/
URINALYSIS; MICROSCOPIC ONLY
URINALYSIS; TWO/THREE GLASS TEST
URINE PREGNANCY TEST, VISUAL COLOR COMPARISON METH
VOLUME MEASUREMENT, TIMED COLLECTION, EACH
UNLISTED URINALYSIS PROC
DMD DUPLICATION/DELETION ANALYSIS
BRCA1, BRCA2 (BREAST CANCER 1 AND 2) (EG, HEREDITARY BREAST AND OVARIAN CANCER) G
ABL1 (ABL PROTO-ONCOGENE 1, NON-RECEPTOR TYROSINE KINASE) (EG, ACQUIRED IMATINIB
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
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1/1/2015
1/1/2015
1/1/2015
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1/1/2015
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1/1/2015
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1/1/2015
1/1/2015
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1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2016
1/1/2016
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
81200
81201
81202
81203
81205
81206
81207
81208
81209
81210
81211
81212
81213
81214
81215
81216
81217
81218
81219
81220
81221
81222
81223
81224
81225
81226
81227
81228
81229
81235
81240
81241
81242
81243
81244
81245
81246
81250
81251
81252
81253
81254
81255
81256
81257
81260
81261
81262
81263
81264
81265
81266
81267
81268
81270
81272
81273
81275
81276
81280
81281
81282
81287
81288
81290
81291
81292
81293
81294
81295
81296
81297
81298
81299
81300
81301
81302
81303
81304
81310
81311
81313
81314
81315
81316
81317
81318
81319
81321
81322
81323
ASPA GENE ANALYSIS COMMON VARIANTS
APC GENE ANALYSIS FULL GENE SEQUENCE
APC GENE ANALYSIS KNOWN FAMILIAL VARIANTS
APC GENE ANALYSIS DUPLICATION/DELETION VARIANTS
BCKDHB GENE ANALYSIS COMMON VARIANTS
BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE
BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE
BCR/ABL1 OTHER BREAKPNT QUALITATIVE/QUANTITATIVE
BLM GENE ANALYSIS 2281DEL6INS7 VARIANT
BRAF GENE ANALYSIS V600E VARIANT
BRCA1&BRCA2 FULL SEQ ANALYS/COMM DUP/DEL BRCA1
BRCA1&BRCA2 ANAL 185DELAG5385INSC/6174DELT
BRCA1&BRCA2 ANAL UNCOMMON DUP/DEL VARIANTS
BRCA1 FULL SEQ ANAL&COMMON DUP/DEL VARIANTS
BRCA1 GENE ANALYSIS KNOWN FAMILIAL VARIANT
BRCA2 GENE ANALYSIS FULL SEQUENCE ANALYSIS
BRCA2 GENE ANALYSIS KNOWN FAMILIAL VARIANT
CEBPA (CCAAT/ENHANCER BINDING PROTEIN [C/EBP], ALPHA) (EG, ACUTE MYELOID LEUKEMIA
CALR (CALRETICULIN) (EG, MYELOPROLIFERATIVE DISORDERS), GENE ANALYSIS, COMMON VAR
CFTR GENE ANALYSIS COMMON VARIANTS
CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS
CFTR GENE ANALYSIS DUPLICATION/DELETION VARIANTS
CFTR GENE ANALYSIS FULL GENE SEQUENCE
CFTR GENE ANALYSIS INTRON 8 POLY-T ANALYSIS
CYP2C19 GENE ANALYSIS COMMON VARIANTS
CYP2D6 GENE ANALYSIS COMMON VARIANTS
CYP2C9 GENE ANALYSIS COMMON VARIANTS
CYTOGENOM CONST MICROARRAY COPY NUMBER VARIANTS
CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR
EGFR GENE ANALYSIS COMMON VARIANTS
F2 GENE ANALYSIS 20210G >A VARIANT
F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT
FANCC GENE ANALYSIS COMMON VARIANT
FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES
FMR1 GENE ANALYSIS CHARACTERIZATION OF ALLELES
FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS
FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS
G6PC GENE ANALYSIS COMMON VARIANTS
GBA GLUCOSIDASE/BETA/ACID ANAL COMM VARIANTS
GJB2 GENE ANALYSIS FULL GENE SEQUENCE
GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS
GJB6 GENE ANALYSIS COMMON VARIANTS
HEXA GENE ANALYSIS COMMON VARIANTS
HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS
HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT
IKBKAP GENE ANALYSIS COMMON VARIANTS
IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED
IGH@ REARRANGE ABNORMAL CLONAL POP DIRECT PROBE
IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS
IGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POP
COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC
COMPARATIVE ANAL STR MARKERS EA ADDL SPECIMEN
CHIMERISM W/COMP TO BASELINE W/O CELL SELECTION
CHIMERISM W/COMP TO BASELINE W/CELL SELECTION EA
JAK2 GENE ANALYSIS P.VAL617PHE VARIANT
KIT (V-KIT HARDY-ZUCKERMAN 4 FELINE SARCOMA VIRAL ONCOGENE HOMOLOG) (EG, GASTRO
KIT (V-KIT HARDY-ZUCKERMAN 4 FELINE SARCOMA VIRAL ONCOGENE HOMOLOG) (EG, MASTO
KRAS GENE ANALYSIS VARIANTS IN CODONS 12 AND 13
KRAS (KIRSTEN RAT SARCOMA VIRAL ONCOGENE HOMOLOG) (EG, CARCINOMA) GENE ANALYS
LONG QT SYNDROME FULL SEQUENCE ANALYSIS
LONG QT SYNDROME ANAL KNOWN FAMILIAL SEQUENCE
LONG QT SYNDROME GENE ANAL DUP/DEL VARIANTS
MGMT METHYLATION ANALYSIS
MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS
MCOLN1 MUCOLIPIN1 GENE ANALYSIS COMMON VARIANTS
MTHFR GENE ANALYSIS COMMON VARIANTS
MLH1 GENE ANALYSIS FULL SEQUENCE ANALYSIS
MLH1 GENE ANALYSIS KNOWN FAMILIAL VARIANTS
MLH1 GENE ANALYSIS DUPLICATION/DELETION VARIANTS
MSH2 GENE ANALYSIS FULL SEQUENCE ANALYSIS
MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS
MSH2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS
MSH6 GENE ANALYSIS FULL SEQUENCE ANALYSIS
MSH6 GENE ANALYSIS KNOWN FAMILIAL VARIANTS
MSH6 GENE ANALYSIS DUPLICATION/DELETION VARIA
MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF
MECP2 GENE ANALYSIS FULL SEQUENCE
MECP2 GENE ANALYSIS KNOWN FAMILIAL VARIANT
MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT
NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS
NRAS (NEUROBLASTOMA RAS VIRAL [V-RAS] ONCOGENE HOMOLOG) (EG, COLORECTAL CARCI
PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN RATIO
PDGFRA (PLATELET-DERIVED GROWTH FACTOR RECEPTOR, ALPHA POLYPEPTIDE) (EG, GASTRO
PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT
PML/RARALPHA SINGLE BREAKPOINT QUAL/QUAN
PMS2 GENE ANALYSIS FULL SEQUENCE
PMS2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS
PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS
PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS
PTEN GENE ANALYSIS KNOWN FAMILIAL VARIANT
PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT
1/1/2012
1/1/2013
1/1/2013
1/1/2013
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2016
1/1/2016
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2013
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2015
1/1/2012
1/1/2012
1/1/2013
1/1/2013
1/1/2013
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2016
1/1/2016
1/1/2012
1/1/2016
1/1/2012
1/1/2012
1/1/2012
1/1/2014
1/1/2015
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2016
1/1/2015
1/1/2016
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2013
1/1/2013
1/1/2013
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
81324
81325
81326
81330
81331
81332
81340
81341
81342
81350
81355
81370
81371
81372
81373
81374
81375
81376
81377
81378
81379
81380
81381
81382
81383
81400
81401
81402
81403
81404
81405
81406
81407
81408
81410
81411
81412
81415
81416
81417
81420
81425
81426
81427
81430
81431
81432
81433
81434
81435
81436
81437
81438
81440
81442
81445
81450
81455
81460
81465
81470
81471
81479
81490
81493
81500
81503
81504
81506
81507
81508
81509
81510
81511
81512
81519
81525
81528
81535
81536
81538
81540
81545
81595
81599
82009
82010
82013
82016
82017
82024
PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS
PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS
PMP22 GENE ANALYSIS KNOWN FAMILIAL VARIANT
SMPD1 GENE ANALYSIS COMMON VARIANTS
SNRPN/UBE3A METHYLATION ANALYSIS
SERPINA1 GENE ANALYSIS COMMON VARIANTS
TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD
TRB@ REARRANGEMENT ANAL DIRECT PROBE METHODOLOGY
TRG@ GENE REARRANGEMENT ANALYSIS
UGT1A1 GENE ANALYSIS COMMON VARIANTS
VKORC1 GENE ANALYSIS COMMON VARIANTS
HLA CLASS I&II LOW HLA-A -B -C -DRB1/3/4/5&-DQB1
HLA I&LI LOW RESOLUTION HLA-A -B&-DRB1
HLA CLASS I TYPING LOW RESOLUTION COMPLETE
HLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACH
HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH
HLA II LOW RESOLUTION HLA-DRB1/3/4/5 AND -DQB1
HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA
HLA II LOW RESOLUTION ONE ANTIGEN EQUIVALENT EA
HLA I&II HIGH RESOLUTION HLA-A -B -C AND -DRB1
HLA CLASS I TYPING HIGH RESOLUTION COMPLETE
HLA CLASS I TYPING HIGH RESOLUTION ONE LOCUS EA
HLA I TYPING HIGH RESOLUTION 1 ALLELE/ALLELE GRP
HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA
HLA II HIGH RESOLUTION 1 ALLELE/ALLELE GROUP
MOLECULAR PATHOLOGY PROCEDURE LEVEL 1
MOLECULAR PATHOLOGY PROCEDURE LEVEL 2
MOLECULAR PATHOLOGY PROCEDURE LEVEL 3
MOLECULAR PATHOLOGY PROCEDURE LEVEL 4
MOLECULAR PATHOLOGY PROCEDURE LEVEL 5
MOLECULAR PATHOLOGY PROCEDURE LEVEL 6
MOLECULAR PATHOLOGY PROCEDURE LEVEL 7
MOLECULAR PATHOLOGY PROCEDURE LEVEL 8
MOLECULAR PATHOLOGY PROCEDURE LEVEL 9
AORTIC DYSFUNCTION/DILATION GENOMIC SEQ ANALYSIS
AORTIC DYSFUNCTION/DILATION DUP/DEL ANALYSIS
ASHKENAZI JEWISH ASSOCIATED DISORDERS, GENOMIC SEQUENCE ANALYSIS PANEL, MUST IN
EXOME SEQUENCE ANALYSIS
EXOME SEQUENCE ANALYSIS EACH COMPARATOR EXOME
EXOME RE-EVAL OF PREVIOUSLY OBTAINED EXOME SEQ
FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS
GENOME SEQUENCE ANALYSIS
GENOME SEQUENCE ANALYSIS EACH COMPARATOR GENOME
GENOME RE-EVALUATION OF PREC OBTAINED GENOME SEQ
HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES
HEARING LOSS DUP/DEL ANALYSIS
HEREDITARY BREAST CANCER-RELATED DISORDERS; GENOMIC SEQUENCE ANALYSIS PANEL, M
HEREDITARY BREAST CANCER-RELATED DISORDERS (EG, HEREDITARY BREAST CANCER, HERED
HEREDITARY RETINAL DISORDERS (EG, RETINITIS PIGMENTOSA, LEBER CONGENITAL AMAUROS
HEREDITARY COLON CA GENOMIC SEQ ANALYS 7 GENES
HEREDITARY COLON CA SYND DUP/DEL ANALYS 8 GENES
HEREDITARY NEUROENDOCRINE TUMOR DISORDERS (EG, MEDULLARY THYROID CARCINOMA,
HEREDITARY NEUROENDOCRINE TUMOR DISORDERS (EG, MEDULLARY THYROID CARCINOMA,
NUCLEAR MITOCHONDRIAL 100 GENE GENOMIC SEQ
NOONAN SPECTRUM DISORDERS, GENOMIC SEQUENCE ANALYSIS PANEL, MUST INCLUDE SEQ
TARGETED GENOMIC SEQ ANALYS DNA ANALYS 5-50 GENE
GENOMIC SEQ ANALYS DNA&RNA ANALYS 5-50 GENE
GENOMIC SEQ ANALYS DNA&RNA ANALYS 51/MORE GENES
WHOLE MITOCHONDRIAL GENOME
WHOLE MITOCHONDRIAL GENOME ANALYSIS PANEL
X-LINKED INTELLECTUAL DBLT GENOMIC SEQ ANALYS
X-LINKED INTELLECTUAL DBLT DUP/DEL GENE ANALYS
UNLISTED MOLELCULAR PATHOLOGY PROCEDURE
AUTOIMMUNE (RHEUMATOID ARTHRITIS), ANALYSIS OF 12 BIOMARKERS USING IMMUNOASS
CORONARY ARTERY DISEASE, MRNA, GENE EXPRESSION PROFILING BY REAL-TIME RT-PCR OF 2
ONCO (OVARIAN) BIOCHEMICAL ASSAY TWO PROTEINS
ONCO (OVARIAN) BIOCHEMICAL ASSAY FIVE PROTEINS
ONCOLOGY TISSUE OF ORIGIN SIMILAR SCOR ALGORITHM
ENDOCRINOLOGY BIOCHEMICAL ASSAY SEVEN ANAL
FETAL ANEUPLOIDY 21 18 13 SEQ ANALY TRISOM RISK
FETAL CONGENITAL ABNOR ASSAY TWO PROTEINS
FETAL CONGENITAL ABNOR ASSAY 3 PROTEINS
FETAL CONGENITAL ABNOR ASSAY THREE ANAL
FETAL CONGENITAL ABNOR ASSAY FOUR ANAL
FETAL CONGENITAL ABNOR ASSAY FIVE ANAL
ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES
ONCOLOGY (COLON), MRNA, GENE EXPRESSION PROFILING BY REAL-TIME RT-PCR OF 12 GENE
ONCOLOGY (COLORECTAL) SCREENING, QUANTITATIVE REAL-TIME TARGET AND SIGNAL AMPL
ONCOLOGY (GYNECOLOGIC), LIVE TUMOR CELL CULTURE AND CHEMOTHERAPEUTIC RESPONS
ONCOLOGY (GYNECOLOGIC), LIVE TUMOR CELL CULTURE AND CHEMOTHERAPEUTIC RESPONS
ONCOLOGY (LUNG), MASS SPECTROMETRIC 8-PROTEIN SIGNATURE, INCLUDING AMYLOID A, U
ONCOLOGY (TUMOR OF UNKNOWN ORIGIN), MRNA, GENE EXPRESSION PROFILING BY REAL-T
ONCOLOGY (THYROID), GENE EXPRESSION ANALYSIS OF 142 GENES, UTILIZING FINE NEEDLE AS
CARDIOLOGY (HEART TRANSPLANT), MRNA, GENE EXPRESSION PROFILING BY REAL-TIME QUA
UNLISTED MULTIANALYTE ASSAY ALGORITHMIC ANALYSIS
KETONE BODIES SERUM QUALITATIVE
KETONE BODIES SERUM QUANTITATIVE
ACETYLCHOLINESTERASE
ACYLCARNITINES; QUALITATIVE, EACH SPECIMEN
ACYLCARNITINES; QUANTITATIVE, EACH SPECIMEN
ASSAY OF ADRENOCORTICOTROPIC HORMONE (ACTH)
1/1/2013
1/1/2013
1/1/2013
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2015
1/1/2015
1/1/2016
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2016
1/1/2016
1/1/2016
1/1/2015
1/1/2015
1/1/2016
1/1/2016
1/1/2015
1/1/2016
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2013
1/1/2016
1/1/2016
1/1/2013
1/1/2013
1/1/2014
1/1/2013
1/1/2014
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2015
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
Y
Y
N
N
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
82030
82040
82042
82043
82044
82045
82075
82085
82088
82103
82104
82105
82106
82107
82108
82120
82127
82128
82131
82135
82136
82139
82140
82143
82150
82154
82157
82160
82163
82164
82172
82175
82180
82190
82232
82239
82240
82247
82248
82252
82261
82270
82271
82272
82274
82286
82300
82306
82308
82310
82330
82331
82340
82355
82360
82365
82370
82373
82374
82375
82376
82378
82379
82380
82382
82383
82384
82387
82390
82397
82415
82435
82436
82438
82441
82465
82480
82482
82485
82486
82487
82488
82489
82491
82492
82495
82507
82523
82525
82528
82530
ADENOSINE, 5-MONOPHOSPHATE, CYCLIC (CYCLIC AMP)
ALBUMIN; SERUM
ALBUMIN; URINE OR OTHER SOURCE, QUANTITATIVE, EACH
ALBUMIN; URINE, MICROALBUMIN, QUANTITATIVE
ALBUMIN; URINE, MICROALBUMIN, SEMIQUANTITATIVE
ALBUMIN; URINE, MICROALBUMIN, ISCHEMIA MODIFIED
ASSAY OF ALCOHOL BREATH
ALDOLASE
ALDOSTERONE
ALPHA-1-ANTITRYPSIN; TOTAL
ALPHA-1-ANTITRYPSIN; PHENOTYPE
ALPHA-FETOPROTEIN; SERUM
ALPHA-FETOPROTEIN; AMNIOTIC FLUID
Alpha-fetoprotein l3
ALUMINUM
AMINES, VAGINAL FLUID, QUALITATIVE
AMINO ACIDS; SINGLE, QUALITATIVE, EACH SPECIMEN
AMINO ACIDS; MULTIPLE, QUALITATIVE, EACH SPECIMEN
AMINO ACIDS; SINGLE, QUANTITATIVE, EACH SPECIMEN
AMINOLEVULINIC ACID, DELTA (ALA)
AMINO ACIDS, 2-5 AMINO ACIDS, QUANTITATIVE, EACH S
AMINO ACIDS, 6 OR MORE AMINO ACIDS, QUANTITATIVE,
AMMONIA
AMNIOTIC FLUID SCAN (SPECTROPHOTOMETRIC)
AMYLASE
ANDROSTANEDIOL GLUCURONIDE
ANDROSTENEDIONE
ANDROSTERONE
ANGIOTENSIN II
ANGIOTENSIN I - CONVERTING ENZYME (ACE)
APOLIPOPROTEIN, EACH
ARSENIC
ASCORBIC ACID (VITAMIN C), BLOOD
ATOMIC ABSORPTION SPECTROSCOPY, EACH ANALYTE
BETA-2 MICROGLOBULIN
BILE ACIDS; TOTAL
BILE ACIDS; CHOLYLGLYCINE
BILIRUBIN; TOTAL
BILIRUBIN; DIRECT
BILIRUBIN; FECES, QUALITATIVE
BIOTINIDASE, EACH SPECIMEN
BLOOD, OCCULT, BY PEROXIDASE ACTIVITY, QUALITATIVE
BLOOD, OCCULT; OTHER SOURCES
Blood, occult, by peroxidase activity (eg. guaiac)
BLOOD, OCCULT, FECAL HEMOGLOBIN DETERMIN, IMMUNOAS
BRADYKININ
CADMIUM
25 HYDROXY INCLUDES FRACTIONS IF PERFORMED
CALCITONIN
CALCIUM; TOTAL
CALCIUM; IONIZED
CALCIUM; AFTER CALCIUM INFUSION TEST
CALCIUM; URINE QUANTITATIVE, TIMED SPECIMEN
CALCULUS; QUALITATIVE ANALYSIS
CALCULUS; QUANTITATIVE ANALYSIS, CHEMICAL
CALCULUS; INFRARED SPECTROSCOPY
CALCULUS; X-RAY DIFFRACTION
CARBOHYDRATE DEFICIENT TRANSFERRIN
CARBON DIOXIDE (BICARBONATE)
CARBON MONOXIDE, (CARBOXYHEMOGLOBIN); QUANTITATIVE
CARBON MONOXIDE, (CARBOXYHEMOGLOBIN); QUALITATIVE
CARCINOEMBRYONIC ANTIGEN (CEA)
CARNITINE (TOTAL AND FREE), QUANTITATIVE, EACH SPE
CAROTENE
CATECHOLAMINES; TOTAL URINE
CATECHOLAMINES; BLOOD
CATECHOLAMINES; FRACTIONATED
CATHEPSIN-D
CERULOPLASMIN
CHEMILUMINESCENT ASSAY
CHLORAMPHENICOL
CHLORIDE; BLOOD
CHLORIDE; URINE
CHLORIDE; OTHER SOURCE
CHLORINATED HYDROCARBONS, SCREEN
CHOLESTEROL, SERUM/WHOLE BLOOD, TOTAL
CHOLINESTERASE; SERUM
CHOLINESTERASE; RBC
CHONDROITIN B SULFATE, QUANTITATIVE
CHROMATOGRAPHY, QUALITATIVE; COLUMN, ANALYTE NOT E
CHROMATOGRAPHY, QUALITATIVE; PAPER, 1-DIMENSIONAL,
CHROMATOGRAPHY, QUALITATIVE; PAPER, 2-DIMENSIONAL,
CHROMATOGRAPHY, QUALITATIVE; THIN LAYER, ANALYTE N
CHROMATOGRAPHY, QUANTITATIVE, COLUMN; SINGLE ANALY
CHROMATOGRAPHY, QUANTITATIVE, COLUMN; MULTIPLE ANA
CHROMIUM
CITRATE
COLLAGEN CROSS LINKS, ANY METHOD
COPPER
CORTICOSTERONE
CORTISOL; FREE
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
82533
82540
82541
82542
82543
82544
82550
82552
82553
82554
82565
82570
82575
82585
82595
82600
82607
82608
82610
82615
82626
82627
82633
82634
82638
82652
82656
82657
82658
82664
82668
82670
82671
82672
82677
82679
82693
82696
82705
82710
82715
82725
82726
82728
82731
82735
82746
82747
82757
82759
82760
82775
82776
82777
82784
82785
82787
82800
82803
82805
82810
82820
82830
82930
82938
82941
82943
82945
82946
82947
82948
82950
82951
82952
82955
82960
82962
82963
82965
82977
82978
82979
82985
83001
83002
83003
83006
83009
83010
83012
83013
CORTISOL; TOTAL
CREATINE
COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE NES
COL-CHR/MS QUAN 1 STATIONARY&MOBILE PHASE NES
COL-CHR/MS STABLE ISOTOPE DIL 1 ANALYTE NES
COL-CHR/MS STABLE ISOTOPE DIL MLT ANALYTES NES
CREATINE KINASE (CK), (CPK); TOTAL
CREATINE KINASE (CK), (CPK); ISOENZYMES
CREATINE KINASE (CK), (CPK); MB FRACTION ONLY
CREATINE KINASE (CK), (CPK); ISOFORMS
CREATININE; BLOOD
CREATININE; OTHER SOURCE
CREATININE; CLEARANCE
CRYOFIBRINOGEN
CRYOGLOBULIN, QUALITATIVE OR SEMI-QUANTITATIVE
CYANIDE
CYANOCOBALAMIN (VITAMIN B-12)
CYANOCOBALAMIN (VITAMIN B-12); UNSATURATED BINDING
CYSTATIN C
CYSTINE AND HOMOCYSTINE, URINE, QUALITATIVE
DEHYDROEPIANDROSTERONE (DHEA)
DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)
DESOXYCORTICOSTERONE, 11DEOXYCORTISOL, 11DIBUCAINE NUMBER
DIHYDROXYVITAMIN D, 1,25ELASTASE, PANCREATIC (El-1) FECAL, QUALITATIVE
ENZYME ACTIVITY, CELLS/TISSUE NOT ELSEWHERE SPECIF
ENZYME ACTIVITY, CELLS/TISSUE NOT ELSEWHERE SPECIF
ELECTROPHORETIC TECHNIQUE, NOT ELSEWHERE SPECIFIED
ERYTHROPOIETIN
ESTRADIOL
ESTROGENS; FRACTIONATED
ESTROGENS; TOTAL
ESTRIOL
ESTRONE
ETHYLENE GLYCOL
ETIOCHOLANOLONE
FAT/LIPIDS, FECES; QUALITATIVE
FAT/LIPIDS, FECES; QUANTITATIVE
FAT DIFFERENTIAL, FECES, QUANTITATIVE
FATTY ACIDS, NONESTERIFIED
VERY LONG CHAIN FATTY ACIDS
FERRITIN
FETAL FIBRONECTIN, CERVICOVAGINAL SECRETIONS, SEMI
FLUORIDE
FOLIC ACID; SERUM
FOLIC ACID; RBC
FRUCTOSE, SEMEN
GALACTOKINASE, RBC
GALACTOSE
GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; QUANTITA
GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE; SCREEN
GALECTIN 3
GAMMAGLOBULIN; IGA, IGD, IGG, IGM, EACH
GAMMAGLOBULIN; IGE
GAMMAGLOBULIN; IMMUNOGLOBULIN SUBCLASSES, (IGG1/2/
GASES, BLOOD, PH ONLY
GASES, BLOOD, PH, PCO2, PO2, CO2, HCO3, (W/CALCULA
GASES, BLOOD, PH, PCO2, PO2, CO2, HCO3; W/O2 SAT,
GASES, BLOOD, O2 SAT ONLY, DIRECT MEASURE, NOT PUL
HEMOGLOBIN-OXYGEN AFFINITY (PO2, 50 PCT HEMOGLOBIN
GASTRIC ACID ANALYIS W/PH EA SPECIMEN
Gastric acid analysis, includes pH if performed, each specimen
GASTRIN AFTER SECRETIN STIMULATION
GASTRIN
GLUCAGON
GLUCOSE, BODY FLUID, OTHER THAN BLOOD
GLUCAGON TOLERANCE TEST
GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP
GLUCOSE; BLOOD, REAGENT STRIP
GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)
GLUCOSE; TOLERANCE TEST (GTT), 3 SPECIMENS (INCLUD
GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS
GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); QUANTITA
GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); SCREEN
GLUCOSE, BLOOD, GLUCOSE MONITORING DEVICE(S) CLEAR
GLUCOSIDASE, BETA
GLUTAMATE DEHYDROGENASE
GLUTAMYLTRANSFERASE, GAMMA (GGT)
GLUTATHIONE
GLUTATHIONE REDUCTASE, RBC
GLYCATED PROTEIN
GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)
GONADOTROPIN; LUTEINIZING HORMONE (LH)
GROWTH HORMONE, HUMAN (HGH) (SOMATOTROPIN)
GROWTH STIMULATION EXPRESSED GENE 2
HELICOBACTER PYLORI, BLLOD TEST ANALYSIS FOR UREAS
HAPTOGLOBIN; QUANTITATIVE
HAPTOGLOBIN; PHENOTYPES
H. PYLORI; ANALYSIS FOR UREASE ACTIVITY, NON-RADIO
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2005
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
83014
83015
83018
83020
83021
83026
83030
83033
83036
83037
83045
83050
83051
83060
83065
83068
83069
83070
83080
83088
83090
83150
83491
83497
83498
83499
83500
83505
83516
83518
83519
83520
83525
83527
83528
83540
83550
83570
83582
83586
83593
83605
83615
83625
83630
83631
83632
83633
83655
83661
83662
83663
83664
83670
83690
83695
83698
83700
83701
83704
83718
83719
83721
83727
83735
83775
83785
83788
83789
83825
83835
83857
83861
83864
83872
83873
83874
83876
83880
83883
83885
83915
83916
83918
83919
83921
83930
83935
83937
83945
83950
BREATH TEST, H. PYLORI, MASS SPECTOMETRY, DRUG ADM
HEAVY METAL (ARSENIC, BARIUM, BERYLLIUM, BISMUTH,
HEAVY METAL (ARSENIC, BARIUM, BERYLLIUM, BISMUTH,
HEMOGLOBIN FRACTIONATION AND QUANTITATION; ELECTRO
HEMOGLOBIN FRACTIONATION AND QUANTITATION; CHROMAT
HEMOGLOBIN; COPPER SULFATE METHOD, NON-AUTOMATED
HEMOGLOBIN; F (FETAL), CHEMICAL
HEMOGLOBIN; F (FETAL), QUALITATIVE
HEMOGLOBIN; GLYCATED
HEMOGLOBIN; GLYCOSYLATED (A1C) BY DEVICE
HEMOGLOBIN; METHEMOGLOBIN, QUALITATIVE
HEMOGLOBIN; METHEMOGLOBIN, QUANTITATIVE
HEMOGLOBIN; PLASMA
HEMOGLOBIN; SULFHEMOGLOBIN, QUANTITATIVE
HEMOGLOBIN; THERMOLABILE
HEMOGLOBIN; UNSTABLE, SCREEN
HEMOGLOBIN; URINE
ASSAY OF HEMOSIDERIN QUALITATIVE
B-HEXOSAMINIDASE, EACH ASSAY
HISTAMINE
HOMOCYSTINE
HOMOVANILLIC ACID (HVA)
HYDROXYCORTICOSTEROIDS, 17- (17-OHCS)
HYDROXYINDOLACETIC ACID, 5-(HIAA)
HYDROXYPROGESTERONE, 17-D
HYDROXYPROGESTERONE, 20HYDROXYPROLINE; FREE
HYDROXYPROLINE; TOTAL
IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP
IMMUNOASSAY ANALYTE QUAL/SEMIQUAL SINGLE STEP
IMMUNOASSAY, ANALYTE, QUANTITATIVE; RADIOPHARMACEU
IMMUNOASSAY, ANALYTE, QUANTITATIVE; NOT OTHERWISE
INSULIN; TOTAL
INSULIN; FREE
INTRINSIC FACTOR
IRON
IRON BINDING CAPACITY
ISOCITRIC DEHYDROGENASE (IDH)
KETOGENIC STEROIDS, FRACTIONATION
KETOSTEROIDS, 17- (17-KS); TOTAL
KETOSTEROIDS, 17- (17-KS); FRACTIONATION
LACTATE (LACTIC ACID)
LACTATE DEHYDROGENASE (LD), (LDH)
LACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEP
LACTOFERRIN, FECAL, QUALITATIVE
LACTOFERRIN, FECAL, QUANITATIVE
LACTOGEN, HUMAN PLACENTAL (HPL) HUMAN CHORIONIC SO
LACTOSE URINE QUALITATIVE
LEAD
FETAL LUNG MATURITY ASSESSMENT; LECITHIN SPHINGOMY
FETAL LUNG MATURITY ASSESSMENT; FOAM STABILITY TES
FETAL LUNG MATURITY ASSESSMENT; FLUORESCENCE POLAR
FETAL LUNG MATURITY ASSESSMENT; LAMELLAR BODY DENS
LEUCINE AMINOPEPTIDASE (LAP)
LIPASE
LIPOPROTEIN (A)
Assay lipoprotein pla2
LIPOPROTEIN, BLOOD, ELCTROPHORETIC SEPARATION & QU
LIPOPROTEIN, BLOOD, HIGH RESOLUTION FRACTIONATION
LIPOPROTEIN, BLOOD, QUANTITATION OF LIPOPROTEIN PA
LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOL
LIPOPROTEIN, DIRECT MEASUREMENT; DIRECT MEASUREMEN
LIPOPROTEIN, DIRECT MEASUREMENT; DIRECT MEASUREMEN
LUTEINIZING RELEASING FACTOR (LRH)
MAGNESIUM
MALATE DEHYDROGENASE
MANGANESE
MASS/TANDEM SPECTROMETRY, ANALYTE NOT ELSEWHERE CL
MASS/TANDEM SPECTROMETRY, ANALYTE NOT ELSEWHERE CL
MERCURY, QUANTITATIVE
METANEPHRINES
METHEMALBUMIN
MICROFLUID ANALYSIS TEAR OSMOLARITY
MUCOPOLYSACCHARIDES ACID QUANTITATIVE
MUCIN, SYNOVIAL FLUID (ROPES TEST)
MYELIN BASIC PROTEIN, CSF
MYOGLOBIN
MYELOPEROXIDASE MPO
NATRIURETIC PEPTIDE
NEPHELOMETRY, EACH ANALYTE NOT ELSEWHERE SPECIFIED
NICKEL
NUCLEOTIDASE 5OLIGOCLONAL IMMUNOGLOBULIN (OLIGOCLONAL BANDS)
ORGANIC ACIDS; TOTAL, QUANTITATIVE, EACH SPECIMEN
ORGANIC ACIDS; QUALITATIVE, EACH SPECIMEN
ORGANIC ACID, SINGLE, QUANTITATIVE
OSMOLALITY; BLOOD
OSMOLALITY; URINE
OSTEOCALCIN (BONE G1A PROTEIN)
OXALATE
ONCOPROTEIN, HER-2/NEU
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2007
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
83951
83970
83986
83987
83992
83993
84030
84035
84060
84061
84066
84075
84078
84080
84081
84085
84087
84100
84105
84106
84110
84112
84119
84120
84126
84132
84133
84134
84135
84138
84140
84143
84144
84145
84146
84150
84152
84153
84154
84155
84156
84157
84160
84163
84165
84166
84181
84182
84202
84203
84206
84207
84210
84220
84228
84233
84234
84235
84238
84244
84252
84255
84260
84270
84275
84285
84295
84300
84302
84305
84307
84311
84315
84375
84376
84377
84378
84379
84392
84402
84403
84425
84430
84431
84432
84436
84437
84439
84442
84443
84445
ONCOPROTEIN DES-GAMMA-CARBOXY-PROTHROMBIN DCP
PARATHORMONE (PARATHYROID HORMONE)
PH, BODY FLUID, EXCEPT BLOOD
PH EXHALED BREATH CONDENSATE
PHENCYCLIDINE (PCP)
CALPROTECTIN FECAL
PHENYLALANINE (PKU), BLOOD
PHENYLKETONES, QUALITATIVE
PHOSPHATASE, ACID; TOTAL
PHOSPHATASE, ACID; FORENSIC EXAM
PHOSPHATASE, ACID; PROSTATIC
PHOSPHATASE, ALKALINE
PHOSPHATASE, ALKALINE; HEAT STABLE (TOTAL NOT INCL
PHOSPHATASE, ALKALINE; ISOENZYMES
PHOSPHATIDYLGLYCEROL
PHOSPHOGLUCONATE, 6-, DEHYDROGENASE, RBC
PHOSPHOHEXOSE ISOMERASE
PHOSPHORUS INORGANIC (PHOSPHATE)
PHOSPHORUS INORGANIC (PHOSPHATE); URINE
PORPHOBILINOGEN, URINE; QUALITATIVE
PORPHOBILINOGEN, URINE; QUANTITATIVE
EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN
PORPHYRINS, URINE; QUALITATIVE
PORPHYRINS, URINE; QUANTITATION AND FRACTIONATION
PORPHYRINS FECES QUANTITATIVE
POTASSIUM; SERUM
POTASSIUM; URINE
PREALBUMIN
PREGNANEDIOL
PREGNANETRIOL
PREGNENOLONE
17-HYDROXYPREGNENOLONE
PROGESTERONE
PROCALCITONIN (PCT)
PROLACTIN
PROSTAGLANDIN, EACH
PROSTATE SPECIFIC ANTIGEN (PSA); COMPLEXED (DIRECT
PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL
PROSTATE SPECIFIC ANTIGEN (PSA); FREE
PROTEIN, TOTAL, EXCEPT REFRACTOMETRY; SERUM
PROTEIN, TOTAL, EXCEPT REFRACTOMETRY; URINE
PROTEIN, TOTAL, EXCEPT REFRACTOMETRY; OTHER
PROTEIN, TOTAL, EXCEPT REFRACTOMETRY; ANY SOURCE
PREGNANCY-ASSOCIATED PLASMA PROTEIN
PROTEIN, ELECTROPHORETIC FRACTIONATION AND QUANTIT
PROTEIN, ELECTROPHORETIC FRACTIONATION AND QUANTIT
PROTEIN; WESTERN BLOT, W/INTERPRETATION AND REPORT
PROTEIN; WESTERN BLOT, W/INTERPRETATION AND REPORT
PROTOPORPHYRIN, RBC; QUANTITATIVE
PROTOPORPHYRIN, RBC; SCREEN
PROINSULIN
PYRIDOXAL PHOSPHATE (VITAMIN B-6)
PYRUVATE
PYRUVATE KINASE
QUININE
RECEPTOR ASSAY; ESTROGEN
RECEPTOR ASSAY; PROGESTERONE
RECEPTOR ASSAY; ENDOCRINE, OTHER THAN ESTROGEN/PRO
RECEPTOR ASSAY; NON-ENDOCRINE
RENIN
RIBOFLAVIN (VITAMIN B-2)
SELENIUM
SEROTONIN
SEX HORMONE BINDING GLOBULIN (SHBG)
SIALIC ACID
SILICA
SODIUM; SERUM
SODIUM; URINE
SODIUM; OTHER SOURCE
SOMATOMEDIN
SOMATOSTATIN
SPECTROPHOTOMETRY, ANALYTE NOT ELSEWHERE SPECIFIED
SPECIFIC GRAVITY (EXCEPT URINE)
SUGARS, CHROMATOGRAPHIC, TLC/PAPER CHROMATOGRAPHY
SUGARS (MONO, DI, AND OLIGOSACCHARIDES); SINGLE QU
SUGARS (MONO, DI, AND OLIGOSACCHARIDES); MULTIPLE
SUGARS (MONO, DI, AND OLIGOSACCHARIDES); SINGLE QU
SUGARS (MONO, DI, AND OLIGOSACCHARIDES); MULTIPLE
SULFATE, URINE
TESTOSTERONE; FREE
TESTOSTERONE; TOTAL
THIAMINE (VITAMIN B-1)
THIOCYANATE
THROMBOXANE METABOLITE W/WO THROMBOXANE URINE
THYROGLOBULIN
THYROXINE; TOTAL
THYROXINE; REQUIRING ELUTION
THYROXINE; FREE
THYROXINE BINDING GLOBULIN (TBG)
THYROID STIMULATING HORMONE (TSH)
THYROID STIMULATING IMMUNOGLOBULINS (TSI)
1/1/2009
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
84446
84449
84450
84460
84466
84478
84479
84480
84481
84482
84484
84485
84488
84490
84510
84512
84520
84525
84540
84545
84550
84560
84577
84578
84580
84583
84585
84586
84588
84590
84591
84597
84600
84620
84630
84681
84702
84703
84704
84830
84999
85002
85004
85007
85008
85009
85013
85014
85018
85025
85027
85032
85041
85044
85045
85046
85048
85049
85055
85060
85097
85130
85170
85175
85210
85220
85230
85240
85244
85245
85246
85247
85250
85260
85270
85280
85290
85291
85292
85293
85300
85301
85302
85303
85305
85306
85307
85335
85337
85345
85347
TOCOPHEROL ALPHA (VITAMIN E)
TRANSCORTIN (CORTISOL BINDING GLOBULIN)
TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)
TRANSFERASE; ALANINE AMINO (ALT) (SGPT)
TRANSFERRIN
TRIGLYCERIDES
THYROID HORMONE (T3/T4) UPTAKE/THYROID HORMONE BIN
TRIIODOTHYRONINE T3; TOTAL (TT-3)
TRIIODOTHYRONINE T3; FREE
TRIIODOTHYRONINE T3; REVERSE
TROPONIN, QUANTITATIVE
TRYPSIN; DUODENAL FLUID
TRYPSIN; FECES, QUALITATIVE
TRYPSIN; FECES, QUANTITATIVE, 24-HOUR COLLECTION
TYROSINE
TROPONIN, QUALITATIVE
UREA NITROGEN; QUANTITATIVE
UREA NITROGEN; SEMIQUANTITATIVE
UREA NITROGEN, URINE
UREA NITROGEN, CLEARANCE
URIC ACID; BLOOD
URIC ACID; OTHER SOURCE
UROBILINOGEN, FECES, QUANTITATIVE
UROBILINOGEN, URINE; QUALITATIVE
UROBILINOGEN, URINE; QUANTITATIVE, TIMED SPECIMEN
UROBILINOGEN, URINE; SEMIQUANTITATIVE
VANILLYLMANDELIC ACID (VMA), URINE
VASOACTIVE INTESTINAL PEPTIDE (VIP)
VASOPRESSIN (ANTIDIURETIC HORMONE, ADH)
VITAMIN A
VITAMIN, NOT OTHERWISE SPECIFIED
VITAMIN K
ASSAY OF VOLATILES
XYLOSE ABSORPTION TEST, BLOOD AND/OR URINE
ZINC
C-PEPTIDE
GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE
GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE
GONADOTROPIN CHORIONIC HCG FREE BETA CHAIN
OVULATION TESTS, VISUAL COLOR COMPARISON METHODS,
UNLISTED CHEMISTRY PROC
BLEEDING TIME
BLOOD COUNT; AUTOMATED DIFFERENTIAL WBC COUNT
BLOOD COUNT; BLOOD SMEAR, MICROSCOP EXAM W/MANUAL
BLOOD COUNT; BLOOD SMEAR, MICROSCOP EXAM W/O MANUA
BLOOD COUNT; MANUAL DIFFERENTIAL WBC COUNT, BUFFY
BLOOD COUNT; SPUN MICROHEMATOCRIT
BLOOD COUNT; HEMATOCRIT
BLOOD COUNT; HEMOGLOBIN
BLOOD COUNT; COMPLETE CBC, AUTOMATED (HGB, HCT, RB
BLOOD COUNT; COMPLETE CBC, AUTOMATED (HGB, HCT, RB
BLOOD COUNT; MANUAL CELL (ERYTHROCYTE, LEUKOCYTE,
BLOOD COUNT; RED BLOOD CELL (RBC), AUTOMATED
BLOOD COUNT; RETICULOCYTE, MANUAL
BLOOD COUNT; RETICULOCYTE, AUTOMATED
BLOOD COUNT; RETICULOCYTES, HEMOGLOBIN CONCENTRATI
BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED
BLOOD COUNT; PLATELET, AUTOMATED
RETICULATED PLATELET ASSAY
BLOOD SMEAR, PERIPHERAL, INTERPRETATION, PHYSICIAN
BONE MARROW, SMEAR INTERPRETATION
CHROMOGENIC SUBSTRATE ASSAY
CLOT RETRACTION
CLOT LYSIS TIME, WHOLE BLOOD DILUTION
CLOTTING; FACTOR II, PROTHROMBIN, SPECIFIC
CLOTTING; FACTOR V (ACG/PROACCELERIN), LABILE FACT
CLOTTING; FACTOR VII (PROCONVERTIN, STABLE FACTOR)
CLOTTING; FACTOR VIII (AHG), ONE STAGE
CLOTTING; FACTOR VIII RELATED ANTIGEN
CLOTTING; FACTOR VIII, VW FACTOR, RISTOCETIN COFAC
CLOTTING; FACTOR VIII, VW FACTOR ANTIGEN
CLOTTING; FACTOR VIII, VW FACTOR, MULTIMETRIC ANAL
CLOTTING; FACTOR IX (PTC/CHRISTMAS)
CLOTTING; FACTOR X (STUART-PROWER)
CLOTTING; FACTOR XI (PTA)
CLOTTING; FACTOR XII (HAGEMAN)
CLOTTING; FACTOR XIII (FIBRIN STABILIZING)
CLOTTING; FACTOR XIII (FIBRIN STABILIZING), SCREEN
CLOTTING; PREKALLIKREIN ASSAY (FLETCHER FACTOR ASS
CLOTTING; HIGH MOLECULAR WT KININOGEN ASSAY (FITZG
CLOTTING INHIBITORS/ANTICOAGULANTS; ANTITHROMBIN I
CLOTTING INHIBITORS/ANTICOAGULANTS; ANTITHROMBIN I
CLOTTING INHIBITORS/ANTICOAGULANTS; PROTEIN C, ANT
CLOTTING INHIBITORS/ANTICOAGULANTS; PROTEIN C, ACT
CLOTTING INHIBITORS/ANTICOAGULANTS; PROTEIN S, TOT
CLOTTING INHIBITORS/ANTICOAGULANTS; PROTEIN S, FRE
ACTIVATED PROTEIN C (APC) RESISTANCE ASSAY
FACTOR INHIBITOR TEST
THROMBOMODULIN
COAGULATION TIME; LEE AND WHITE
COAGULATION TIME; ACTIVATED
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
85348
85360
85362
85366
85370
85378
85379
85380
85384
85385
85390
85396
85397
85400
85410
85415
85420
85421
85441
85445
85460
85461
85475
85520
85525
85530
85536
85540
85547
85549
85555
85557
85576
85597
85598
85610
85611
85612
85613
85635
85651
85652
85660
85670
85675
85705
85730
85732
85810
85999
86000
86001
86003
86005
86021
86022
86023
86038
86039
86060
86063
86077
86078
86079
86140
86141
86146
86147
86148
86152
86153
86155
86156
86157
86160
86161
86162
86171
86185
86200
86215
86225
86226
86235
86243
86255
86256
86277
86280
86294
86300
COAGULATION TIME; OTHER METHODS
EUGLOBULIN LYSIS
FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FS
FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FS
FIBRIN(OGEN) DEGRADATION (SPLIT) PRODUCTS (FDP)(FS
FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUALITATIVE
FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE
FIBRIN DEGRADATION PRODUCTS, D-DIMER; ULTRASENSITI
FIBRINOGEN; ACTIVITY
FIBRINOGEN; ANTIGEN
FIBRINOLYSINS/COAGULOPATHY SCREEN, INTERPRETATION
COAGULATION/FIBRINOLYSIS, WHOLE BLOOD, W/ USE, ADD
COAGJ&FIBRINOLYSIS FUNCTIONAL ACTV NOS EA ANAL
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMIN
FIBRINOLYTIC FACTORS AND INHIBITORS; ALPHA-2 ANTIP
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN A
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN,
FIBRINOLYTIC FACTORS AND INHIBITORS; PLASMINOGEN,
HEINZ BODIES; DIRECT
HEINZ BODIES; INDUCED, ACETYL PHENYLHYDRAZINE
HEMOGLOBIN/RBCS, FETAL, FETOMATERNAL HEMORRHAGE; D
HEMOGLOBIN/RBCS, FETAL, FETOMATERNAL HEMORRHAGE; R
HEMOLYSIN, ACID
HEPARIN ASSAY
HEPARIN NEUTRALIZATION
HEPARIN-PROTAMINE TOLERANCE TEST
IRON STAIN PERIPHERAL BLOOD
LEUKOCYTE ALKALINE PHOSPHATASE W/COUNT
MECHANICAL FRAGILITY, RBC
MURAMIDASE
OSMOTIC FRAGILITY, RBC; UNINCUBATED
OSMOTIC FRAGILITY, RBC; INCUBATED
PLATELET, AGGREGATION (IN VITRO), EACH AGENT
PHOSPHOLIPID NEUTRALIZATION PLATELET
PHOSPHOLIPID NEUTRALIZATION HEXAGONAL
PROTHROMBIN TIME
PROTHROMBIN TIME; SUBSTITUTION, PLASMA FRACTIONS,
RUSSELL VIPER VENOM TIME (INCLUDES VENOM); UNDILUT
RUSSELL VIPER VENOM TIME (INCLUDES VENOM); DILUTED
REPTILASE TEST
SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED
SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED
SICKLING, RBC, REDUCTION
THROMBIN TIME; PLASMA
THROMBIN TIME; TITER
THROMBOPLASTIN INHIBITION; TISSUE
THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA/WHOLE B
THROMBOPLASTIN TIME, PARTIAL (PTT); SUBSTITUTION,
VISCOSITY
UNLISTED HEMATOLOGY AND COAGULATION PROC
AGGLUTININS, FEBRILE, EACH ANTIGEN
ALLERGEN SPECIFIC IGG QUANTITATIVE/SEMIQUANTITATIV
ALLERGEN SPECIFIC IGE; QUANTITATIVE/SEMIQUANTITATI
ALLERGEN SPECIFIC IGE; QUALITATIVE, MULTIALLERGEN
ANTIBODY IDENTIFICATION; LEUKOCYTE ANTIBODIES
ANTIBODY IDENTIFICATION; PLATELET ANTIBODIES
ANTIBODY IDENTIFICATION; PLATELET ASSOCIATED IMMUN
ANTINUCLEAR ANTIBODIES (ANA)
ANTINUCLEAR ANTIBODIES (ANA); TITER
ANTISTREPTOLYSIN 0; TITER
ANTISTREPTOLYSIN 0; SCREEN
BLOOD BANK PHYSICIAN SERVICES; DIFFICULT CROSS MAT
BLOOD BANK PHYSICIAN SERVICES; INVESTIGATION, TRAN
BLOOD BANK PHYSICIAN SERVICES; AUTHORIZATION, DEVI
C-REACTIVE PROTEIN
C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)
BETA 2 GLYCOPROTEIN I ANTIBODY, EA
CARDIOLIPIN (PHOSPHOLIPID) ANTIBODY, EA IG CLASS
ANTI-PHOSPHATIDYLSERINE (PHOSPHOLIPID) ANTIBODY
CELL ENUMERATION IMMUNE SELECTJ & ID FLUID SPEC
CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP
CHEMOTAXIS ASSAY, SPECIFY METHOD
COLD AGGLUTININ; SCREEN
COLD AGGLUTININ; TITER
COMPLEMENT; ANTIGEN, EACH COMPONENT
COMPLEMENT; FUNCTIONAL ACTIVITY, EACH COMPONENT
COMPLEMENT; TOTAL HEMOLYTIC (CH50)
COMPLEMENT FIXATION TESTS, EACH ANTIGEN
COUNTERIMMUNOELECTROPHORESIS, EACH ANTIGEN
CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY
DEOXYRIBONUCLEASE, ANTIBODY
DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE/DOUBL
DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; SINGLE STRAN
EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METH
FC RECEPTOR
FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN,
FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; TITER, E
GROWTH HORMONE, HUMAN (HGH), ANTIBODY
HEMAGGLUTINATION INHIBITION TEST (HAI)
IMMUNOASSAY, TUMOR ANTIGEN, QUALITATIVE/SEMIQUANTI
IMMUNOASSAY, TUMOR ANTIGEN, QUANTITATIVE; CA 15-3
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
86301
86304
86305
86308
86309
86310
86316
86317
86318
86320
86325
86327
86329
86331
86332
86334
86335
86336
86337
86340
86341
86343
86344
86352
86353
86355
86356
86357
86359
86360
86361
86367
86376
86378
86382
86384
86386
86403
86406
86430
86431
86480
86481
86485
86486
86490
86510
86580
86590
86592
86593
86602
86603
86606
86609
86611
86612
86615
86617
86618
86619
86622
86625
86628
86631
86632
86635
86638
86641
86644
86645
86648
86651
86652
86653
86654
86658
86663
86664
86665
86666
86668
86671
86674
86677
86682
86684
86687
86688
86689
86692
IMMUNOASSAY, TUMOR ANTIGEN, QUANTITATIVE; CA 19-9
IMMUNOASSAY, TUMOR ANTIGEN, QUANTITATIVE; CA 125
HUMAN EPIDIDYMIS PROTEIN 4 (HE4)
HETEROPHILE ANTIBODIES; SCREENING
HETEROPHILE ANTIBODIES; TITER
HETEROPHILE ANTIBODIES; TITERS AFTER ABSORPTION W/
IMMUNOASSAY, TUMOR ANTIGEN; OTHER ANTIGEN, QUANTIT
IMMUNOASSAY, INFECTIOUS AGENT ANTIBODY, QUANTITATI
IMMUNOASSAY, INFECTIOUS AGENT ANTIBODY, QUALITATIV
IMMUNOELECTROPHORESIS; SERUM
IMMUNOELECTROPHORESIS; OTHER FLUIDS W/CONCENTRATIO
IMMUNOELECTROPHORESIS; CROSSED (2-DIMENSIONAL ASSA
IMMUNODIFFUSION; NOT ELSEWHERE SPECIFIED
IMMUNODIFFUSION; GEL DIFFUSION, QUALITATIVE (OUCHT
IMMUNE COMPLEX ASSAY
IMMUNOFIXATION ELECTROPHORESIS
IMMUNOFIXATION ELECTROPHORESIS, OTHER FLUIDS WITH
INHIBIN A
INSULIN ANTIBODIES
INTRINSIC FACTOR ANTIBODIES
ISLET CELL ANTIBODY
LEUKOCYTE HISTAMINE RELEASE TEST (LHR)
LEUKOCYTE PHAGOCYTOSIS
CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKER
LYMPHOCYTE TRANSFORMATION, MITOGEN (PHYTOMITOGEN)/
B CELLS; TOTAL COUNT
MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA
NATURAL KILLER (NK) CELLS, TOTAL COUNT
T CELLS; TOTAL COUNT
T CELLS; ABSOLUTE CD4 AND CD8 COUNT, W/RATIO
T CELLS; ABSOLUTE CD4 COUNT
STEM CELLS (IE CD34); TOTAL COUNT
MICROSOMAL ANTIBODIES, EACH
MIGRATION INHIBITORY FACTOR TEST (MIF)
NEUTRALIZATION TEST, VIRAL
NITROBLUE TETRAZOLIUM DYE TEST (NTD)
NUCLEAR MATRIX PROTEIN 22 NMP22 QUALITATIVE
PARTICLE AGGLUTINATION; SCREEN, EACH ANTIBODY
PARTICLE AGGLUTINATION; TITER, EACH ANTIBODY
RHEUMATOID FACTOR; QUALITATIVE
RHEUMATOID FACTOR; QUANTITATIVE
TB TEST, CELL MEDIATED IMMUNITY MEASUREMENT OF GAM
TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP
SKIN TEST; CANDIDA
SKIN TEST UNLISTED ANTIGEN EACH
SKIN TEST; COCCIDIOIDOMYCOSIS
SKIN TEST; HISTOPLASMOSIS
SKIN TEST; TUBERCULOSIS, INTRADERMAL
STREPTOKINASE, ANTIBODY
SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL
SYPHILIS TEST; QUANTITATIVE
ANTIBODY; ACTINOMYCES
ANTIBODY; ADENOVIRUS
ANTIBODY; ASPERGILLUS
ANTIBODY; BACTERIUM, NOT ELSEWHERE SPECIFIED
ANTIBODY; BARTONELLA
ANTIBODY; BLASTOMYCES
ANTIBODY; BORDETELLA
ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) CONF
ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE)
ANTIBODY; BORRELIA (RELAPSING FEVER)
ANTIBODY; BRUCELLA
ANTIBODY; CAMPYLOBACTER
ANTIBODY; CANDIDA
ANTIBODY; CHLAMYDIA
ANTIBODY; CHLAMYDIA, IGM
ANTIBODY; COCCIDIOIDES
ANTIBODY; COXIELLA BRUNETII (Q FEVER)
ANTIBODY; CRYPTOCOCCUS
ANTIBODY; CYTOMEGALOVIRUS (CMV)
ANTIBODY; CYTOMEGALOVIRUS (CMV), IGM
ANTIBODY; DIPHTHERIA
ANTIBODY; ENCEPHALITIS, CALIFORNIA (LA CROSSE)
ANTIBODY; ENCEPHALITIS, EASTERN EQUINE
ANTIBODY; ENCEPHALITIS, ST. LOUIS
ANTIBODY; ENCEPHALITIS, WESTERN EQUINE
ANTIBODY; ENTEROVIRUS
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (V
ANTIBODY; EHRLICHIA
ANTIBODY; FRANCISELLA TULARENSIS
ANTIBODY; FUNGUS, NOT ELSEWHERE SPECIFIED
ANTIBODY; GIARDIA LAMBLIA
ANTIBODY; HELICOBACTER PYLORI
ANTIBODY; HELMINTH, NOT ELSEWHERE SPECIFIED
ANTIBODY; HEMOPHILUS INFLUENZA
ANTIBODY; HTLV-I
ANTIBODY; HTLV-II
ANTIBODY; HTLV/HIV ANTIBODY, CONFIRMATORY TEST
ANTIBODY; HEPATITIS, DELTA AGENT
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2006
1/1/2008
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2011
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
86694
86695
86696
86698
86701
86702
86703
86704
86705
86706
86707
86708
86709
86710
86711
86713
86717
86720
86723
86727
86729
86732
86735
86738
86741
86744
86747
86750
86753
86756
86757
86759
86762
86765
86768
86771
86774
86777
86778
86780
86784
86787
86788
86789
86790
86793
86800
86803
86804
86805
86806
86807
86808
86812
86813
86816
86817
86821
86822
86825
86826
86828
86829
86830
86831
86832
86833
86834
86835
86849
86850
86860
86870
86880
86885
86886
86890
86891
86900
86901
86902
86904
86905
86906
86910
86911
86920
86921
86922
86923
86927
ANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE TEST
ANTIBODY; HERPES SIMPLEX, TYPE I
ANTIBODY; HERPES SIMPLEX, TYPE 2
ANTIBODY; HISTOPLASMA
ANTIBODY; HIV-1
ANTIBODY; HIV-2
ANTIBODY HIV-1&HIV-2 SINGLE RESULT
HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL
HEPATITIS B CORE ANTIBODY (HBCAB); IGM ANTIBODY
HEPATITIS B SURFACE ANTIBODY (HBSAB)
HEPATITIS BE ANTIBODY (HBEAB)
HEPATITIS A ANTIBODY (HAAB); TOTAL
HEPATITIS A ANTIBODY (HAAB); IGM ANTIBODY
ANTIBODY; INFLUENZA VIRUS
ANTIBODY JOHN CUNNINGHAM VIRUS
ANTIBODY; LEGIONELLA
ANTIBODY; LEISHMANIA
ANTIBODY; LEPTOSPIRA
ANTIBODY; LISTERIA MONOCYTOGENES
ANTIBODY; LYMPHOCYTIC CHORIOMENINGITIS
ANTIBODY; LYMPHOGRANULOMA VENEREUM
ANTIBODY; MUCORMYCOSIS
ANTIBODY; MUMPS
ANTIBODY; MYCOPLASMA
ANTIBODY; NEISSERIA MENINGITIDIS
ANTIBODY; NOCARDIA
ANTIBODY; PARVOVIRUS
ANTIBODY; PLASMODIUM (MALARIA)
ANTIBODY; PROTOZOA, NOT ELSEWHERE SPECIFIED
ANTIBODY; RESPIRATORY SYNCYTIAL VIRUS
ANTIBODY; RICKETTSIA
ANTIBODY; ROTAVIRUS
ANTIBODY; RUBELLA
ANTIBODY; RUBEOLA
ANTIBODY; SALMONELLA
ANTIBODY; SHIGELLA
ANTIBODY; TETANUS
ANTIBODY; TOXOPLASMA
ANTIBODY; TOXOPLASMA, IGM
ANTIBODY TREPONEMA PALLIDUM
ANTIBODY; TRICHINELLA
ANTIBODY; VARICELLA-ZOSTER
West nile virus ab, igm
West nile virus antibody
ANTIBODY; VIRUS, NOT ELSEWHERE SPECIFIED
ANTIBODY; YERSINIA
THYROGLOBULIN ANTIBODY
HEPATITIS C ANTIBODY
HEPATITIS C ANTIBODY; CONFIRMATORY TEST
LYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; W/TIT
LYMPHOCYTOTOXICITY ASSAY, VISUAL CROSSMATCH; W/O T
SERUM SCREENING, CYTOTOXIC PERCENT REACTIVE ANTIBO
SERUM SCREENING, CYTOTOXIC PERCENT REACTIVE ANTIBO
HLA TYPING; A, B, OR C, SINGLE ANTIGEN
HLA TYPING; A, B, OR C, MULTIPLE ANTIGENS
HLA TYPING; DR/DQ, SINGLE ANTIGEN
HLA TYPING; DR/DQ, MULTIPLE ANTIGENS
HLA TYPING; LYMPHOCYTE CULTURE, MIXED (MLC)
HLA TYPING; LYMPHOCYTE CULTURE, PRIMED (PLC)
HLA CROSSMATCH NONCYTOTOXIC 1ST SERUM/DILUTION
HLA CROSSMATCH NONCYTOTOXIC EA+ SERUM/DILUTION
ANTIBODY HLA CLASS I & CLASS II ANTIGENS QUAL
ANTIBODY HLA CLASS I OR CLASS II ANTIGENS QUAL
ANTIBODY HLA CLASS I PHENOTYPE PANEL QUALITATIVE
ANTIBODY HLA CLASS II PHENOTYPE PANEL QUAL
ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL
ANTIBODY HLA CLASS II HIGH DEFINITION PANEL QUAL
ANTIBODY HLA CLASS I SEMIQUANTITATIVE PANEL
ANTIBODY HLA CLASS II SEMIQUANTITATIVE PANEL
UNLISTED IMMUNOLOGY PROC
ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE
ANTIBODY ELUTION (RBC), EACH ELUTION
ANTIBODY IDENTIFICATION, RBC ANTIBODIES, EACH PANE
ANTIHUMAN GLOBULIN TEST (COOMBS TEST); DIRECT, EAC
ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, Q
ANTIHUMAN GLOBULIN TEST (COOMBS TEST); INDIRECT, T
AUTOLOGOUS BLOOD/COMPONENT, COLLECT/PROCESS/STORAG
AUTOLOGOUS BLOOD/COMPONENT, COLLECT/PROCESS/STORAG
BLOOD TYPING SEROLOGIC ABO
BLOOD TYPING SEROLOGIC RH (D)
BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH
BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT
BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH
BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE
BLOOD TYPING, PATERNITY TESTING, PER INDIVIDUAL; A
BLOOD TYPING, PATERNITY TESTING, PER INDIVIDUAL; E
COMPATIBILITY TEST EACH UNIT; IMMEDIATE SPIN TECHN
COMPATIBILITY TEST EACH UNIT; INCUBATION TECHNIQUE
COMPATIBILITY TEST EACH UNIT; ANTIGLOBULIN TECHNIQ
COMPATIBILITY TEST EACH UNIT; ELECTRONIC
FRESH FROZEN PLASMA, THAWING, EACH UNIT
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2010
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
86930
86931
86932
86940
86941
86945
86950
86960
86965
86970
86971
86972
86975
86976
86977
86978
86985
86999
87003
87015
87040
87045
87046
87070
87071
87073
87075
87076
87077
87081
87084
87086
87088
87101
87102
87103
87106
87107
87109
87110
87116
87118
87140
87143
87147
87149
87150
87152
87153
87158
87164
87166
87168
87169
87172
87176
87177
87181
87184
87185
87186
87187
87188
87190
87197
87205
87206
87207
87209
87210
87220
87230
87250
87252
87253
87254
87255
87260
87265
87267
87269
87270
87271
87272
87273
87274
87275
87276
87277
87278
87279
FROZEN BLOOD, EACH UNIT; FREEZING (W/PREPARATION)
FROZEN BLOOD, EACH UNIT; THAWING
FROZEN BLOOD, EACH UNIT; FREEZING (W/PREPARATION)A
HEMOLYSINS AND AGGLUTININS; AUTO, SCREEN, EACH
HEMOLYSINS AND AGGLUTININS; INCUBATED
IRRADIATION, BLOOD PRODUCT, EACH UNIT
LEUKOCYTE TRANSFUSION
VOLUME REDUCTION OF BLOOD OR BLOOD PRODUCT, EACH U
POOLING, PLATELETS/OTHER BLOOD PRODUCTS
PRETREATMENT RBCS, ANTIBODY DETECTION/ID/COMPATIBI
PRETREATMENT RBCS, ANTIBODY DETECTION/ID/COMPATIBI
PRETREATMENT RBCS, ANTIBODY DETECTION/ID/COMPATIBI
PRETREATMENT, SERUM, USE IN RBC ANTIBODY IDENTIFIC
PRETREATMENT, SERUM, USE IN RBC ANTIBODY IDENTIFIC
PRETREATMENT, SERUM, USE IN RBC ANTIBODY IDENTIFIC
PRETREATMENT SERUM, USE IN RBC ANTIBODY IDENTIFICA
SPLITTING, BLOOD/BLOOD PRODUCTS, EACH UNIT
UNLISTED TRANSFUSION MEDICINE PROC
ANIMAL INOCULATION SMALL ANIMAL W/OBS&DSJ
CONCENTRATION (ANY TYPE), FOR INFECTIOUS AGENTS
CULTURE, BACTERIAL; BLOOD, AEROBIC, W/ ISOLATN/PRE
CULTURE, BACTERIAL; STOOL, AEROBIC, W/ ISOLATN/PRE
CULTURE, BACTERIAL; STOOL, AEROBIC, ADDL PATHOGENS
CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE/
CULTURE, BACTERIAL; QUANTIT, AEROBIC W/ISOLATN AND
CULTURE, BACTERIAL; QUANTIT, ANAEROBIC W/ISOLATN A
CULTURE, BACTERIAL; ANY SOURCE, EXCEPT BLOOD, ANAE
CULTURE, BACTERIAL; ANAEROBIC ISOLATE, ADDL METHOD
CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDL METHODS
CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREEN
CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREEN
CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URI
CULTURE, BACTERIAL; W/ISOLATION AND PRESUMPTIVE ID
CULTURE, FUNGI (MOLD/YEAST) ISOLATION, W/PRESUMPTI
CULTURE, FUNGI (MOLD/YEAST) ISOLATION, W/PRESUMPTI
CULTURE, FUNGI (MOLD/YEAST) ISOLATION, W/PRESUMPTI
CULTURE, FUNGI, DEFINITIVE ID, EACH ORGANISM; YEAS
CULTURE, FUNGI, DEFINITIVE ID, EACH ORGANISM; MOLD
CULTURE, MYCOPLASMA, ANY SOURCE
CULTURE, CHLAMYDIA, ANY SOURCE
CULTURE, TUBERCLE/ACID-FAST BACILLI ANY SOURCE, W/
CULTURE, MYCOBACTERIAL, DEFINITIVE ID, EA ISOLATE
CULTURE, TYPING; IMMUNOFLUORESCENT METHOD, EA ANTI
CULTURE, TYPING; GAS LIQUID CHROMATOGRAPHY (GLC)/H
CULTURE, TYPING; IMMUNOLOGIC METHOD, OTHER THAN IM
CULTURE, TYPING; ID BY NUCLEIC ACID PROBE
CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM
CULTURE, TYPING; ID BY PULSE FIELD GEL TYPING
CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE
CULTURE, TYPING; OTHER METHODS
DARK FIELD EXAM, ANY SOURCE; W/SPECIMEN COLLECTION
DARK FIELD EXAM, ANY SOURCE; W/O COLLECTION
MACROSCOPIC EXAM; ARTHROPOD
MACROSCOPIC EXAM; PARASITE
PINWORM EXAM
HOMOGENIZATION, TISSUE, FOR CULTURE
OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AN
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; AGAR
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; DISK
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; ENZYM
SUSCEPT STUDIES, ANTIMICROB AGNT; MICRODILUT/AGAR
SUSCEPTIBILITY STUDIES, ANTIMICROB AGENT; MICRODIL
SUSCEPTIBILITY STUDIES, ANTIMICROB AGENT; MACROBRO
SUSCEPTIBILITY STUDIES, ANTIMICROB AGENT; MYCOBACT
SERUM BACTERICIDAL TITER (SCHLICTER TEST)
SMEAR, PRIMARY SOURCE W/INTERPRETATION; GRAM OR GI
SMEAR, PRIME SRCE, W/INTERPR; FLUORESC AND/OR ACID
SMEAR, PRIMARY SOURCE W/INTERPRETATION; SPECIAL ST
SMEAR; COMPLEX SPECIAL STAIN FOR OVA AND PARASITES
SMEAR, PRIMARY SOURCE W/INTERPRETATION; WET MOUNT,
TISSUE EXAM BY KOH SLIDE OF SAMPLES FROM SKIN/HAIR
TOXIN/ANTITOXIN ASSAY, TISSUE CULTURE
VIRUS ISOLATION; INOCULATION EGGS/SMALL ANIMAL, OB
VIRUS ISOLATION; TISSUE CULTURE INOCULATION, OBSER
VIRUS ISOLATION; TISSUE CULTURE, ADDL STUDIES/DEFI
VIRUS ISOLATION; CENTRIFUGE ENHANCED (SHELL VIAL)
VIRUS ISOLATION; ID, NON-IMMUNOLOGIC METHOD, OTHER
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION, IMMUNOFLUORESC
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORO
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORO
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
87280
87281
87283
87285
87290
87299
87300
87301
87305
87320
87324
87327
87328
87329
87332
87335
87336
87337
87338
87339
87340
87341
87350
87380
87385
87389
87390
87391
87400
87420
87425
87427
87430
87449
87450
87451
87470
87471
87472
87475
87476
87477
87480
87481
87482
87485
87486
87487
87490
87491
87492
87493
87495
87496
87497
87498
87500
87501
87502
87503
87505
87506
87507
87510
87511
87512
87515
87516
87517
87520
87521
87522
87525
87526
87527
87528
87529
87530
87531
87532
87533
87534
87535
87536
87537
87538
87539
87540
87541
87542
87550
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORE
IMMUNOFLUORESCENT TECHNIQUE, POLYVALENT FOR MULTIP
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
Aspergillus ag, eia
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA) QUALITATIVE/SEMIQUANTITAT
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA) QUALITATIVE/SEMIQUANTITAT
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA) QUALITAT/SEMIQUANTITAT, M
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
IAAD EIA HIV-1 AG W/HIV-1&HIV-2 ANTBDY SINGLE
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA), QUALITATIVE/SEMIQUANTITA
ENZYME IMMUNOASSAY (EIA) QUALITATIVE/SEMIQUANTITAT
ENZYME IMMUNOASSAY (EIA) QUALITATIVE/SEMIQUANTITAT
ENZYME IMMUNOASSAY QUALIT/SEMIQUANTIT; MULTI STEP
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); BARTONEL
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); BARTONEL
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); BARTONEL
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); BORRELIA
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); BORRELIA
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); BORRELIA
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CANDIDA,
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CANDIDA,
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CANDIDA,
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CHLAMYDI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CHLAMYDI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CHLAMYDI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CHLAMYDI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CHLAMYDI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CHLAMYDI
INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CYTOMEGA
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CYTOMEGA
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); CYTOMEGA
IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP
INFECTIOUS AGENT DNA/RNA VANCOMYCIN RESISTANCE
INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE
INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
NFCT AGENT DNA/RNA INFLUENZA 1+ TYPES EA ADDL
NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN
IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11
IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); GARDNERE
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); GARDNERE
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); GARDNERE
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HEPATITI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HEPATITI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HEPATITI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HEPATITI
IADNA HEPATITIS C AMPLIFIED PROBE&REVRSE TRANSCR
IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HEPATITI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HEPATITI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HEPATITI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HERPES S
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HERPES S
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HERPES S
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HERPES V
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HERPES V
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HERPES V
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HIV-1, D
IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ
IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); HIV-2, D
IADNA HIV-2 AMPLIFIED PROBE & REVERSE TRANSCRIPJ
IADNA HIV-2 QUANT & REVERSE TRANSCRIPTION
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); LEGIONEL
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); LEGIONEL
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); LEGIONEL
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOBACT
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2008
1/1/2011
1/1/2011
1/1/2011
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
87551
87552
87555
87556
87557
87560
87561
87562
87580
87581
87582
87590
87591
87592
87623
87624
87625
87631
87632
87633
87640
87641
87650
87651
87652
87653
87660
87661
87797
87798
87799
87800
87801
87802
87803
87804
87806
87807
87808
87809
87810
87850
87880
87899
87900
87901
87902
87903
87904
87905
87906
87910
87912
87999
88000
88005
88007
88012
88014
88016
88020
88025
88027
88028
88029
88036
88037
88040
88045
88099
88104
88106
88108
88112
88120
88121
88125
88130
88140
88141
88142
88143
88147
88148
88150
88152
88153
88154
88155
88160
88161
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOBACT
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOBACT
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOBACT
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOBACT
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOBACT
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOBACT
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOBACT
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOBACT
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOPLAS
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOPLAS
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); MYCOPLAS
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); NEISSERI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); NEISSERI
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); NEISSERI
IADNA HUMAN PAPILLOMAVIRUS LOW-RISK TYPES
IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES
IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY
IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS
IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS
IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET
Staph a, dna, amp probe
Mr-staph, dna, amp probe
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); STREPTOC
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); STREPTOC
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); STREPTOC
Strep b, dna, amp probe
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA); TRICHOMO
IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA), NOS; DIR
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA), NOS; AMP
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA), NOS; QUA
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA), MULTIPLE
INFECTIOUS AGENT, NUCLEIC ACID (DNA/RNA), MULTIPLE
INFECTIOUS AGENT, IMMUNOASSAY, DIRECT OBSERVATION;
INFECTIOUS AGENT, IMMUNOASSAY, DIRECT OBSERVATION;
INFECTIOUS AGENT, IMMUNOASSAY, DIRECT OBSERVATION;
IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES
INFECTIOUS AGENT, IMMUNOASSAY, DIRECT OBSERVATION;
Trichomonas assay w/optic
INFECTIOUS AGENT IMMUNOASSAY OPTICAL ADENOVIRUS
INFECTIOUS AGENT, IMMUNOASSAY, DIRECT OBSERVATION;
INFECTIOUS AGENT, IMMUNOASSAY, DIRECT OBSERVATION;
INFECTIOUS AGENT, IMMUNOASSAY, DIRECT OBSERVATION;
INFECTIOUS AGENT, IMMUNOASSAY, DIRECT OBSERVATION;
INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENO TYPE PR
NFCT AGT GEXYP HIV 1 REV TRANSCRIP&PROTEAS REGNS
INFECTIOUS AGENT GENOTYPE ANALYSIS, NUCLEIC ACID (
INFECT AGNT PHENOTYP ANALYS (DNA/RNA) W/DRUG RESIS
INFECT AGNT PHENOTYP ANALYS (DNA/RNA) W/DRUG RESIS
INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS
NFCT GEXYP DNA/RNA HIV 1 OTHER REGION
NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS
NFCT AGENT GENOTYPE HEPATITIS B VIRUS
UNLISTED MICROBIOLOGY PROC
NECROPSY (AUTOPSY), GROSS EXAM ONLY; W/O CNS
NECROPSY (AUTOPSY), GROSS EXAM ONLY; W/BRAIN
NECROPSY (AUTOPSY), GROSS EXAM ONLY; W/BRAIN AND S
NECROPSY (AUTOPSY), GROSS EXAM ONLY; INFANT W/BRAI
NECROPSY (AUTOPSY), GROSS EXAM ONLY; STILLBORN/NEW
NECROPSY (AUTOPSY), GROSS EXAM ONLY; MACERATED STI
NECROPSY (AUTOPSY), GROSS AND MICROSCOPIC; W/O CNS
NECROPSY (AUTOPSY), GROSS AND MICROSCOPIC; W/BRAIN
NECROPSY (AUTOPSY), GROSS AND MICROSCOPIC; W/BRAIN
NECROPSY (AUTOPSY), GROSS AND MICROSCOPIC; INFANT
NECROPSY (AUTOPSY), GROSS AND MICROSCOPIC; STILLBO
NECROPSY (AUTOPSY), LIMITED, GROSS AND/OR MICROSCO
NECROPSY (AUTOPSY), LIMITED, GROSS AND/OR MICROSCO
NECROPSY (AUTOPSY); FORENSIC EXAM
NECROPSY (AUTOPSY); CORONERS CALL
UNLISTED NECROPSY (AUTOPSY) PROC
CYTOPATHOLOGY EXCEPT CERVICAL/VAGINAL; SMEARS W/IN
CYTOPATHOLOGY EXCEPT CERVICAL/VAGINAL; FILTER W/IN
CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND
CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANCEMENT, W/
CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL
CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA
CYTOPATHOLOGY, FORENSIC
SEX CHROMATIN IDENTIFICATION; BARR BODIES
SEX CHROMATIN IDENTIFICATION; PERIPHERAL BLOOD SME
CYTOPATHOLOGY, CERVICAL/VAGINAL; REQUIRING INTERPR
CYTOPATHOLOGY, CERVICAL/VAGINAL, PRESERVATIVE FLUI
CYTOPATHOLOGY, CERVICAL/VAGINAL, PRESERVATIVE FLUI
CYTOPATHOLOGY, CERVICAL/VAGINAL; AUTOMATED SCREEN
CYTOPATHOLOGY, CERVICAL/VAGINAL; AUTOMATED SCREEN,
CYTOPATHOLOGY, SLIDES, CERVICAL/VAGINAL; MANUAL SC
CYTOPATHOLOGY, SLIDES, CERVICAL/VAGINAL; MANUAL SC
CYTOPATHOLOGY, SLIDES, CERVICAL/VAGINAL; MANUAL SC
CYTOPATHOLOGY, SLIDES, CERVICAL/VAGINAL; MANUAL SC
CYTOPATHOLOGY, SLIDES, CERVICAL/VAGINAL, HORMONAL
CYTOPATHOLOGY, SMEARS, OTHER SOURCE; SCREENING AND
CYTOPATHOLOGY, SMEARS, OTHER SOURCE; PREPARATION,
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2015
1/1/2013
1/1/2013
1/1/2013
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2005
1/1/2007
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2011
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
88162
88164
88165
88166
88167
88172
88173
88174
88175
88177
88182
88184
88185
88187
88188
88189
88199
88230
88233
88235
88237
88239
88240
88241
88245
88248
88249
88261
88262
88263
88264
88267
88269
88271
88272
88273
88274
88275
88280
88283
88285
88289
88291
88299
88300
88302
88304
88305
88307
88309
88311
88312
88313
88314
88319
88321
88323
88325
88329
88331
88332
88333
88334
88341
88342
88344
88346
88347
88348
88350
88355
88356
88358
88360
88361
88362
88363
88364
88365
88366
88367
88368
88369
88371
88372
88373
88374
88375
88377
88380
88381
CYTOPATHOLOGY, SMEARS, OTHER SOURCE; EXTENDED STUD
CYTOPATHOLOGY, SLIDES, CERVICAL/VAGINAL, BETHESDA;
CYTOPATHOLOGY, SLIDES, CERVICAL/VAGINAL, BETHESDA;
CYTOPATHOLOGY, SLIDES, CERVICAL/VAGINAL, BETHESDA;
CYTOPATHOLOGY, SLIDES, CERVICAL/VAGINAL, BETHESDA;
CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST
CYTOPATHOLOGY, EVAL FINE NEEDLE ASPIRATE; INTERPRE
CYTOPATHOLOGY, CERVICAL/VAGINAL, AUTO THIN LAYER P
CYTOPATHOLOGY, CERVICAL/VAGINAL, AUTO THIN LAYER P
CYTP C/V AUTO THIN LYR PREPJ ADEQUACY EA EVAL
FLOW CYTOMETRY; CELL CYCLE/DNA ANALYSIS
FLOW CYTOMETRY, CELL SURFACE, FIRST MARKER
FLOW CYTOMETRY, CELL SURFACE, ADDITIONAL MARKER
FLOW CYTOMETRY, INTERPRETATION, 2 TO 8 MARKERS
FLOW CYTOMETRY, INTERPRETATION, 9 TO 15 MARKERS
FLOW CYTOMETRY, INTERPRETATION, 16 OR MORE MARKERS
UNLISTED CYTOPATHOLOGY PROC
TISSUE CULTURE, NON-NEOPLASTIC DISORDERS; LYMPHOCY
TISSUE CULTURE, NON-NEOPLASTIC DISORDERS; SKIN/OTH
TISSUE CULTURE, NON-NEOPLASTIC DISORDERS; AMNIOTIC
TISSUE CULTURE, NEOPLASTIC DISORDERS; BONE MARROW,
TISSUE CULTURE, NEOPLASTIC DISORDERS; SOLID TUMOR
CRYOPRESERVATION, FREEZING AND STORAGE, CELLS, EAC
THAWING AND EXPANSION, FROZEN CELLS, EACH ALIQUOT
CHROMOSOME ANALYSIS, BREAKAGE SYNDROMES; BASELINE
CHROMOSOME ANALYSIS, BREAKAGE SYNDROMES; BASELINE
CHROMOSOME ANALYSIS, BREAKAGE SYNDROMES; 100 CELLS
CHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KARYOTYPE, W
CHROMOSOME ANALYSIS; COUNT 15-20 CELLS, 2 KARYOTYP
CHROMOSOME ANALYSIS; COUNT 45 CELLS, MOSAICISM, 2
CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS
CHROMOSOME ANALYSIS AMNIOTIC FLUID/CHORIONIC VILLU
CHROMOSOME ANALYSIS IN SITU, AMNIOTIC FLUID CELLS,
MOLECULAR CYTOGENETICS; DNA PROBE, EACH
MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRID
MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRID
MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDI
MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDI
CHROMOSOME ANALYSIS; ADDL KARYOTYPES, EACH STUDY
CHROMOSOME ANALYSIS; ADDL SPECIALIZED BANDING TECH
CHROMOSOME ANALYSIS; ADDL CELLS COUNTED, EACH STUD
CHROMOSOME ANALYSIS; ADDL HIGH RESOLUTION STUDY
CYTOGENETICS AND MOLECULAR CYTOGENETICS, INTERPRET
UNLISTED CYTOGENETIC STUDY
LEVEL I - SURGICAL PATHOLOGY, GROSS EXAM ONLY
LEVEL II - SURGICAL PATHOLOGY, GROSS AND MICROSCOP
LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCO
LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOP
LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPI
LEVEL VI - SURGICAL PATHOLOGY, GROSS AND MICROSCOP
DECALCIFICATION PROC
SPECIAL STAINS; GROUP I, MICROORGANISMS, EACH
SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT&IMHIS
SPECIAL STAINS; HISTOCHEMICAL STAINING W/FROZEN SE
SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS
CONSULTATION AND REPORT, REFERRED SLIDES PREPARED
CONSULTATION AND REPORT, REFERRED MATL REQUIRING P
CONSULTATION AND REPORT, REFERRED MATL, COMPREHENS
PATHOLOGY CONSULTATION DURING SURGERY
PATHOLOGY CONSULTATION DURING SURGERY; FIRST TISSU
PATH CONSLTJ SURG EA BLK FROZEN SCTJ
PATHOLOGY CONSULT DURING SURG; CYTOLOGICAL EXAMINA
PATH CONSLTJ SURG CYTOL XM EA ADDL
IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE
IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE
IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE
IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; DIRECT MET
IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; INDIRECT M
ELECTRON MICROSCOPY DIAGNOSTIC
IMMUNOFLUORESCENCE, PER SPECIMEN; EACH ADDITIONAL SINGLE ANTIBODY STAIN PROCED
MORPHOMETRIC ANALYSIS; SKELETAL MUSCLE
MORPHOMETRIC ANALYSIS; NERVE
MORPHOMETRIC ANALYSIS; TUMOR (DNA PLOIDY)
M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST
NERVE TEASING PREPARATIONS
EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSIS
IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
IN SITU HYBRIDIZATION 1ST PROBE STAIN
IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN
M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN
M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL
M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH
PROTEIN ANALYSIS, TISSUE, WESTERN BLOT, W/INTERPRE
PROTEIN ANALYSIS, TISSUE, WESTERN BLOT, W/INTERPRE
M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH
M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB
OPTICAL ENDOMICROSCOPIC IMAGE INTERP & REPORT
M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
MICRODISSECTION (MECHANICAL, LASER CAPTURE)
MICRODISSECTION PREP IDENTIFIED TARGET MANUAL
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2005
1/1/2005
1/1/2005
1/1/2005
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2003
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2015
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2011
1/1/2015
1/1/2004
1/1/2015
1/1/2005
1/1/2005
1/1/2015
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2013
1/1/2015
1/1/2004
1/1/2008
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
88387
88388
88399
88720
88738
88740
88741
88749
89049
89050
89051
89055
89060
89125
89160
89190
89220
89230
89240
89250
89251
89253
89254
89255
89257
89258
89259
89260
89261
89264
89268
89272
89280
89281
89290
89291
89300
89310
89320
89321
89322
89325
89329
89330
89331
89335
89337
89342
89343
89344
89346
89352
89353
89354
89356
89398
90281
90283
90284
90287
90288
90291
90296
90371
90375
90376
90378
90384
90385
90386
90389
90393
90396
90399
90460
90461
90471
90472
90473
90474
90476
90477
90581
90585
90586
90620
90621
90625
90630
90632
90633
MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA
MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SEC
UNLISTED SURGICAL PATHOLOGY PROC
BILIRUBIN TOTAL TRANSCUTANEOUS
HGB QUANTITATIVE TRANSCUTANEOUS
HEMOGLOBIN QUAN TC PER DAY CARBOXYHEMOGLOBIN
HEMOGLOBIN QUANTITATIVE TC PER DAY METHEMOGLOBIN
UNLISTED IN VIVO LAB SERVICE
CAFFEINE HALOTHAN CONTRACTURE TEST (CHCT) FOR MALI
CELL COUNT, MISCELLANEOUS BODY FLUIDS, EXCEPT BLOO
CELL COUNT, MISCELLANEOUS BODY FLUIDS, EXCEPT BLOO
LEUKOCYTE ASSESSMENT, FECAL, QUALITATIVE/SEMIQUANT
CRYSTAL ID, LIGHT MICROSCOPY, BODY FLUID, EXCEPT U
FAT STAIN, FECES, URINE/RESPIRATORY SECRETIONS
MEAT FIBERS, FECES
NASAL SMEAR, EOSINOPHILS
SPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNI
SWEAT COLLECTION BY IONTOPHORESIS
UNLISTED MISCELLANEOUS PATHOLOGY TEST
CULTURE, OOCYTE(S)/EMBRYO(S), LESS THAN 4 DAYS;
CULTURE, OOCYTE(S)/EMBRYO(S), LESS THAN 4 DAYS; W/
ASSISTED EMBRYO HATCHING, MICROTECHNIQUES (ANY MET
OOCYTE IDENTIFICATION, FOLLICULAR FLUID
PREPARATION, EMBRYO, TRANSFER (ANY METHOD)
SPERM IDENTIFICATION, ASPIRATION (OTHER THAN SEMIN
CRYOPRESERVATION; EMBRYO(S)
CRYOPRESERVATION; SPERM
SPERM ISOLATION; SIMPLE PREP, FOR INSEMINATION/DIA
SPERM ISOLATION; COMPLEX PREP, FOR INSEMINATION/DI
SPERM IDENTIFICATION, TESTIS TISSUE, FRESH/CRYOPRE
INSEMINATION, OOCYTES
EXTENDED CULTURE, OOCYTE(S)/EMBRYO(S), 4-7 DAYS
ASSISTED OOCYTE FERTILIZATION, MICROTECHNIQUE; LES
ASSISTED OOCYTE FERTILIZATION, MICROTECHNIQUE; GRE
BX, OOCYTE POLAR BODY/EMBRYO BLASTOMERE, MICROTECH
BX, OOCYTE POLAR BODY/EMBRYO BLASTOMERE, MICROTECH
SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY, SPERM W/
SEMEN ANALYSIS; MOTILITY AND COUNT W/O HUHNER TEST
SEMEN ANALYSIS; COMPLETE (VOLUME, COUNT, MOTILITY,
SEMEN ANALYSIS, PRESENCE AND/OR MOTILITY OF SPERM
SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA
SPERM ANTIBODIES
SPERM EVALUATION; HAMSTER PENETRATION TEST
SPERM EVALUATION; CERVICAL MUCUS PENETRATION TEST,
SPERM EVALUATION RETROGRADE EJACULATION URINE
CRYOPRESERVATION, REPRODUCTIVE TISSUE, TESTICULAR
CRYOPRESERVATION MATURE OOCYTE(S)
STORAGE, (PER YEAR); EMBRYO(S)
STORAGE, (PER YEAR); SPERM/SEMEN
STORAGE, (PER YEAR); REPRODUCTIVE TISSUE, TESTICUL
STORAGE, (PER YEAR); OOCYTE
THAWING, CRYOPRESERVED; EMBRYO(S)
THAWING, CRYOPRESERVED; SPERM/SEMEN, EACH ALIQUOT
THAWING, CRYOPRESERVED; REPRODUCTIVE TISSUE, TESTI
THAWING, CRYOPRESERVED; OOCYTES, EACH ALIQUOT
UNLISTED REPRODUCTIVE MEDICINE LAB PROCEDURE
IMMUNE GLOBULIN (IG), HUMAN, IM USE
IMMUNE GLOBULIN (IGIV), HUMAN, IV USE
IMMUNE GLOBULIN HUMAN SUBQ INFUSION 100 MG EA
BOTULINUM ANTITOXIN, EQUINE, ANY ROUTE
BOTULISM IMMUNE GLOBULIN, HUMAN, IV USE
CYTOMEGALOVIRUS IMMUNE GLOBULIN (CMV-IGIV), HUMAN,
DIPHTHERIA ANTITOXIN, EQUINE, ANY ROUTE
HEPATITIS B IMMUNE GLOBULIN (HBIG), HUMAN, IM USE
RABIES IMMUNE GLOBULIN (RIG), HUMAN, IM AND/OR SUB
RABIES IMMUNE GLOBULIN, HEAT-TREATED, HUMAN, IM AN
RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN (RSV-I
RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, FULL-DOSE, I
RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, MINI-DOSE, I
RHO(D) IMMUNE GLOBULIN (RHIGIV), HUMAN, IV USE
TETANUS IMMUNE GLOBULIN (TIG), HUMAN, IM USE
VACCINIA IMMUNE GLOBULIN, HUMAN, IM USE
VARICELLA-ZOSTER IMMUNE GLOBULIN, HUMAN, IM USE
UNLISTED IMMUNE GLOBULIN
IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX
IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT
IMMUNIZATION ADMINISTRATION; 1 SINGLE/COMBINATION
IMMUNIZATION ADMINISTRATION; EACH ADDL SINGLE/COMB
IMMUNIZATION ADMINISTRATION, INTRANASAL/ORAL; 1 SI
IMMUNIZATION ADMINISTRATION, INTRANASAL/ORAL; EA A
ADENOVIRUS VACCINE, TYPE 4, LIVE, ORAL USE
ADENOVIRUS VACCINE, TYPE 7, LIVE, ORAL USE
ANTHRAX VACCINE SUBCUTANEOUS/IM USE
BACILLUS CALMETTE-GUERIN VACCINE (BCG), TUBERCULOS
BACILLUS CALMETTE-GUERIN VACCINE (BCG), BLADDER CA
MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM
MENB RECOMBINANT LIPOPROTEIN VACCINE IM
CHOLERA VACCINE, LIVE, ADULT DOSAGE, 1 DOSE SCHEDULE, FOR ORAL USE
IIV4 INFLUENZA VACCINE 4 VALENT PRSRV FREE ID
HEPATITIS A VACCINE, ADULT DOSAGE, IM USE
HEPATITIS A VACCINE, PEDIATRIC/ADOLESCENT DOSAGE-2
1/1/2010
1/1/2010
1/1/2004
1/1/2009
1/1/2010
1/1/2009
1/1/2009
1/1/2011
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2015
1/1/2016
1/1/2015
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
90634
90636
90644
90645
90646
90647
90648
90649
90650
90651
90653
90654
90655
90656
90657
90658
90660
90661
90662
90664
90666
90667
90668
90669
90670
90672
90673
90675
90676
90680
90681
90685
90686
90687
90688
90690
90691
90692
90693
90696
90697
90698
90700
90702
90703
90704
90705
90706
90707
90708
90710
90712
90713
90714
90715
90716
90717
90719
90720
90721
90723
90725
90727
90732
90733
90734
90735
90736
90738
90739
90740
90743
90744
90746
90747
90748
90749
90785
90791
90792
90832
90833
90834
90836
90837
90838
90839
90840
90845
90846
90847
HEPATITIS A VACCINE, PEDIATRIC/ADOLESCENT DOSAGE-3
HEPATITIS A AND HEPATITIS B VACCINE (HEPA-HEPB), A
MENINGOCOCCAL & HIB-MENCY VACCINE 4 DOSE IM
HEMOPHILUS INFLUENZA B VACCINE (HIB), HBOC CONJUGA
HEMOPHILUS INFLUENZA B VACCINE (HIB), PRP-D CONJUG
HEMOPHILUS INFLUENZA B VACCINE, PRP-OMP, 3 DOSE SC
HEMOPHILUS INFLUENZA B VACCINE (HIB),PRP-T CONJUGA
HUMAN PAPILLOMA VIRUS (HPV) VACCINE, FOR IM USE
HPV TYP 16 18 BIVALENT 3 DOSE SCHED IM
HPV HUMAN PAPILLOMA VIRUS VACC 9 VAL 3 DOSE IM
INFLUENZA VACCINE INACT SUBUNIT ADJUVANT IM
INFLUENZA VACC IIV3 SPLIT VIRUS PRSRV FREE ID
INFLUENZA VACC TRIVALENT PRSRV FREE 6-35 MO IM
INFLUENZA VIRUS VACC SPLIT PRSRV FREE 3 YRS/> IM
INFLUENZA VIRUS VACCINE SPLIT VIRUS 6-35 MO IM
INFLUENZA VIRUS VACCINE SPLIT VIRUS 3/> YRS IM
INFLUENZA VIRUS VACCINE LIVE INTRANASAL
INFLUENZA VACCINE CELL CULT PRSRV FREE IM
INFLUENZA VACCINE SPLT PRSRV FREE INC ANTIGEN IM
INFLUENZA VACCINE PANDEMIC LIVE INTRANASAL USE
INFLUENZA VACCINE PANDEMIC PRSV FREE IM USE
INFLUENZA VACCINE PANDEMIC ADJUVANT IM USE
INFLUENZA VACCINE PANDEMIC IM USE
PNEUMOCOCCAL CONJUGATE VACCINE, POLYVALENT, CHILDR
PNEUMOCOCCAL VACCINE 13 VALENT IM
INFLUENZA VIRUS VAC QUADRIVALENT LIVE INTRANASAL
INFLUENZA VIRUS VACCINE TRIVALEN RIV3 PRSR FR IM
RABIES VACCINE, IM USE
RABIES VACCINE, INTRADERMAL USE
ROTAVIRUS VACCINE, TETRAVALENT, LIVE, ORAL USE
ROTAVIRUS VACCINE PENTAV 2 DOSE SCHED LIVE ORAL
INFLUENZA VAC QUADRIVALENT PRSRV FREE 6-35 MO IM
INFLUENZA VAC 4 VALENT PRSRV FREE 3 YRS PLUS IM
INFLUENZA VACCINE QUADRIVALENT 6-35 MO IM
INFLUENZA VACCINE QUADRIVALENT 3 YRS PLUS IM
TYPHOID VACCINE, LIVE, ORAL
TYPHOID VACCINE, VI CAPSULAR POLYSACCHARIDE (VICPS
TYPHOID VACCINE, HEAT- AND PHENOL-INACTIVATED (H-P
TYPHOID VACCINE, ACETONE-KILLED, DRIED (AKD), SUBDTAP-IPV VACCINE 4-6 YR IM
DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR
DTAP - HIB - IPV VACCINE, IM USE
DIPHTHERIA, TETANUS TOXOIDS, AND ACELLULAR PERTUSS
DIPHTHERIA AND TETANUS TOXOIDS (DT) ADSORBED, INDI
TETANUS TOXOID ADSORBED, IM USE
INDIVIDUAL PSYCHOTHERAPY, OFFICE, 20-30 MIN
MEASLES VIRUS VACCINE, LIVE, SUB-Q USE
RUBELLA VIRUS VACCINE, LIVE, SUB-Q USE
MEASLES, MUMPS AND RUBELLA VIRUS VACCINE (MMR), LI
MEASLES AND RUBELLA VIRUS VACCINE, LIVE, SUB-Q USE
MEASLES, MUMPS, RUBELLA, AND VARICELLA VACCINE (MM
POLIOVIRUS VACCINE, (ANY TYPE(S)) (OPV), LIVE, ORA
POLIOVIRUS VACCINE, INACTIVATED, (IPV), SUBQ USE
TETANUSAND DIPTHERIA TOXOIDS; ABSORBED; 7 YRS OR O
TETANUS, DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSIS
VARICELLA VIRUS VACCINE, LIVE, SUBQ USE
YELLOW FEVER VACCINE, LIVE, SUBQ USE
DIPHTHERIA TOXOID, IM USE
DTP/HIB VACCINE, IM
DTAP/HIB VACCINE INTRAMUSCULAR
DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
CHOLERA VACCINE, INJECTABLE USE
PLAGUE VACCINE, IM USE
PNEUMOCOCCAL POLYSACCHARIDE VACCINE, 23-VALENT, AD
MENINGOCOCCAL POLYSACCHARIDE VACCINE (ANY GROUP(S)
MENINGOCOCCAL CONJ VACCINE QUADRAVALENT IM
JAPANESE ENCEPHALITIS VIRUS VACCINE, SUBQ USE
ZOSTER VACCINE, LIVE FOR SUBQ USE
JAPANESE ENCEPHALITIS VIRUS VACCINE INACTIVE IM
HEPATITIS B VACCINE ADULT 2 DOSE IM
HEPATITIS B VACCINE, DIALYSIS/IMMUNOSUPPRESSED PAT
HEPATITIS B VACCINE, ADOLESCENT (2-DOSE SCHEDULE),
HEPATITIS B VACCINE, PEDIATRIC/ADOLESCENT, (3-DOSE
HEPATITIS B VACCINE ADULT 3 DOSE IM
HEPATITIS B VACCINE, DIALYSIS/IMMUNOSUPPRESSED PAT
HEPATITIS B AND HEMOPHILUS INFLUENZA B VACCINE (HE
UNLISTED VACCINE/TOXOID
PSYCHOTHERAPY COMPLEX INTERACTIVE
PSYCHIATRIC DIAGNOSTIC EVALUATION
PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES
PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES
PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN
PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES
PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN
PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES
PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN
PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES
PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES
PSYCHOANALYSIS
FAMILY PSYCHOTHERAPY (W/O PATIENT PRESENT)
FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (W/P
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2008
1/1/2015
1/1/2013
1/1/2011
1/1/2004
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
7/1/2010
7/1/2010
7/1/2010
7/1/2010
1/1/2004
7/1/2009
1/1/2013
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
7/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
7/1/2008
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
90849
90853
90863
90865
90867
90868
90869
90870
90875
90876
90880
90882
90885
90887
90889
90899
90901
90911
90935
90937
90940
90945
90947
90951
90952
90953
90954
90955
90956
90957
90958
90959
90960
90961
90962
90963
90964
90965
90966
90967
90968
90969
90970
90989
90993
90997
90999
91010
91013
91020
91022
91030
91034
91035
91037
91038
91040
91065
91110
91111
91112
91117
91120
91122
91132
91133
91200
91299
92002
92004
92012
92014
92015
92018
92019
92020
92025
92060
92065
92071
92072
92081
92082
92083
92100
92132
92133
92134
92136
92140
92145
MULTIPLE-FAMILY GROUP PSYCHOTHERAPY
GROUP PSYCHOTHERAPY (OTHER THAN, MULTIPLE-FAMILY G
PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY
NARCOSYNTHESIS, PSYCHIATRIC DX AND THERAPEUTIC PUR
REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&MNG
THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNGT
REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MNGT
ELECTROCONVULSIVE THERAPY (INCL NECESSARY MONITORI
INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN
INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN
HYPNOTHERAPY
ENVIRONMENTAL INTERVENTION, MEDICAL PURPOSES, PSYC
PSYCHIATRIC EVAL, RECORDS, MEDICAL DIAGNOSTIC PURP
INTERPRETATION/EXPLANATION RESULTS, PSYCHIATRIC/ME
PREP REPORT PT PSYCH STATUS AGENCY/PAYER
UNLISTED PSYCHIATRIC SERVICE/PROC
BIOFEEDBACK TRAINING, ANY MODALITY
BIOFEEDBACK, PERINEAL MUSCLES/ANORECTAL/URETHRAL S
HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION
HEMODIALYSIS, REPEATED EVAL, W/WO REVISION DIALYSI
HEMODIALYSIS ACCESS FLOW STUDY, BY INDICATOR DILUT
DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL
DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS
ESRD RELATED SVC MONTHLY & <2 YR OLD 4/> VISITS
ESRD RELATED SVC MONTHLY <2 YR OLD 2/3 VISITS
ESRD RELATED SVC MONTHLY <2 YR OLD 1 VISIT
ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/> VISITS
ESRD RELATED SVC MONTHLY 2-11 YR OLD 2/3 VISITS
ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT
ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/>VISITS
ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS
ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT
ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS
ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS
ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT
ESRD SVC HOME DIALYSIS FULL MONTH <2YR OLD
ESRD SVC HOME DIALYSIS FULL MONTH 2-11 YR OLD
ESRD SVC HOME DIALYSIS FULL MONTH 12-19 YR OLD
ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD
ESRD RELATED SVC <FULL MONTH < 2 YR OLD
ESRD RELATED SVC <FULL MONTH 2-11 YR OLD
ESRD RELATED SVC <FULL MONTH 12-19 YR OLD
ESRD RELATED SVC <FULL MONTH 20&> YR OLD
DIALYSIS TRAINING, PATIENT, W/HELPER WHERE APPLICA
DIALYSIS TRAINING, PATIENT, W/HELPER WHERE APPLICA
HEMOPERFUSION
UNLISTED DIALYSIS PROC, INPATIENT/OUTPATIENT
ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT
ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION
GASTRIC MOTILITY (MANOMETRIC) STUDIES
DUODENAL MOTILITY STUDY
ESOPHAGUS, ACID PERFUSION TEST, ESOPHAGITIS
ESOPHAGUS, GASTRO REFLUX TEST, RECORDING, ANALYSIS
ESOPHAGUS, GASTRO REFLUX TEST, RECORDING, WITH MUC
ESOPHAGEAL FUNCTION TEST,GASTRO REFLUX TEST WITH A
ESOPHAGEAL FUNCTION TEST,GASTRO REFLUX TEST WITH A
ESOPHAGEAL BALLOON DISTENSION PROVOCATION STUDY
BREATH HYDROGEN/METHANE TEST
GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R
GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP
COLON MOTILITY STDY MIN 6 HR CONT RECORD W/I&R
RECTAL SENSATION, TONE, AND COMPLIANCE TEST
ANORECTAL MANOMETRY
ELECTROGASTROGRAPHY, DIAGNOSTIC, TRANSCUTANEOUS
ELECTROGASTROGRAPHY, DIAGNOSTIC, TRANSCUTANEOUS; W
LIVER ELASTOGRAPHY W/O IMAG W/I&R
UNLISTED DX GASTROENTEROLOGY PROC
OPHTHALMOLOGICAL MEDICAL EXAM AND EVAL; INTERMEDIA
OPHTHALMOLOGICAL MEDICAL EXAM AND EVAL; COMPREHENS
OPHTHALMOLOGICAL MEDICAL EXAM AND EVAL; INTERMEDIA
OPHTHALMOLOGICAL MEDICAL EXAM AND EVAL; COMPREHENS
DETERMINATION, REFRACTIVE STATE
OPHTHALMOLOGICAL EXAM AND EVAL, UNDER GEN ANES, WI
OPHTHALMOLOGICAL EXAM & EVAL, UNDER GEN ANES; LTD
GONIOSCOPY (SEP PROC)
Corneal topography
SENSORIMOTOR EXAM W/MULTIPLE MEASUREMENTS, OCULAR
ORTHOPTIC AND/OR PLEOPTIC TRAINING, W/CONTINUING M
FIT CONTACT LENS TX OCULAR SURFACE DISEASE
FITTING CONTACT LENS FOR MNGT OF KERATOCONUS
VISUAL FIELD EXAM, UNILAT/BILAT W/INTERPRETATION A
VISUAL FIELD EXAM, UNILAT/BILAT W/INTERPRETATION A
VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM
SERIAL TONOMETRY (SEP PROC) MULTIPLE MEASURE, EXTE
CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI
COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE
COMPUTERIZED OPHTHALMIC IMAGING RETINA
OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFERO
PROVOCATIVE TESTS, GLAUCOMA, W/INTERPRETATION AND
CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI
1/1/2004
1/1/2004
1/1/2013
1/1/2004
1/1/2011
1/1/2011
1/1/2012
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2006
1/1/2004
1/1/2005
1/1/2005
1/1/2005
1/1/2005
1/1/2005
1/1/2004
1/1/2004
1/1/2007
1/1/2013
1/1/2011
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2015
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
92225
92226
92227
92228
92230
92235
92240
92250
92260
92265
92270
92275
92283
92284
92285
92286
92287
92310
92311
92312
92313
92314
92315
92316
92317
92325
92326
92340
92341
92342
92352
92353
92354
92355
92358
92370
92371
92499
92502
92504
92507
92508
92511
92512
92516
92520
92521
92522
92523
92524
92526
92531
92532
92533
92534
92537
92538
92540
92541
92542
92543
92544
92545
92546
92547
92548
92550
92551
92552
92553
92555
92556
92557
92558
92559
92560
92561
92562
92563
92564
92565
92567
92568
92570
92571
92572
92575
92576
92577
92579
92582
EXTENDED OPHTHALMOSCOPY W/RETINAL DRAWING, W/INTER
EXTENDED OPHTHALMOSCOPY W/RETINAL DRAWING, W/INTER
REMOTE IMG DX RETINL DIS W/ALYS & REPORT UNI/BI
REMOTE IMG MGT RETINL DIS W/I&R UNI/BI
FLUORESCEIN ANGIOSCOPY W/INTERPRETATION AND REPORT
FLUORESCEIN ANGIOGRAPHY (W/MULTIFRAME IMAGING) W/I
INDOCYANINE-GREEN ANGIOGRAPHY (W/MULTIFRAME IMAGIN
FUNDUS PHOTOGRAPHY W/INTERPRETATION AND REPORT
OPHTHALMODYNAMOMETRY
NEEDLE OCULOELECTROMYOGRAPHY, PLUS 1 EXTRAOCULAR M
ELECTRO-OCULOGRAPHY W/INTERPRETATION AND REPORT
ELECTRORETINOGRAPHY W/INTERPRETATION AND REPORT
COLOR VISION EXAM, EXTENDED
DARK ADAPTATION EXAM W/INTERPRETATION AND REPORT
EXT OCULAR PHOTOGRAPHY W/INTERPRETATION AND REPORT
ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY
ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R
PRESCRIPTION/FITTING CONTACT LENS W/MEDICAL SUPERV
PRESCRIPTION/FITTING CONTACT LENS W/MEDICAL SUPERV
PRESCRIPTION/FITTING CONTACT LENS W/MEDICAL SUPERV
PRESCRIPTION/FITTING CONTACT LENS W/MEDICAL SUPERV
PRESCRIPTION/FITTING CONTACT LENS W/MEDICAL SUPERV
PRESCRIPTION/FITTING CONTACT LENS W/MEDICAL SUPERV
PRESCRIPTION/FITTING CONTACT LENS W/MEDICAL SUPERV
PRESCRIPTION/FITTING CONTACT LENS W/MEDICAL SUPERV
MODIFICATION, CONTACT LENS (SEP PROC), W/MEDICAL S
REPLACEMENT, CONTACT LENS
FITTING, SPECTACLES, EXCEPT APHAKIA; MONOFOCAL
FITTING, SPECTACLES, EXCEPT APHAKIA; BIFOCAL
FITTING, SPECTACLES, EXCEPT APHAKIA; MULTIFOCAL, O
FITTING, SPECTACLE PROSTHESIS, APHAKIA; MONOFOCAL
FITTING, SPECTACLE PROSTHESIS, APHAKIA; MULTIFOCAL
FITTING, SPECTACLE MOUNTED LOW VISION AID; SINGLE
FITTING, SPECTACLE MOUNTED LOW VISION AID; TELESCO
PROSTHESIS SERVICE, APHAKIA, TEMPORARY (DISPOSABLE
REPAIR AND REFITTING SPECTACLES; EXCEPT APHAKIA
REPAIR AND REFITTING SPECTACLES; SPECTACLE PROSTHE
UNLISTED OPHTHALMOLOGICAL SERVICE/PROC
OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA
BINOCULAR MICROSCOPY (SEP DX PROC)
SPEECH/HEARING/VOICE/COMMUNICATION THERAPY; INDIVI
SPEECH/HEARING/VOICE/COMMUNICATION THERAPY; GROUP,
NASOPHARYNGOSCOPY W/ENDOSCOPE (SEP PROC)
NASAL FUNCTION STUDIES
FACIAL NERVE FUNCTION STUDIES
LARYNGEAL FUNCTION STUDIES
EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)
EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE
EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION
BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE
TREATMENT, SWALLOWING DYSFUNCTION AND/OR ORAL FUNC
SPONTANEOUS NYSTAGMUS, W/GAZE
POSITIONAL NYSTAGMUS
CALORIC VESTIBULAR TEST, EACH IRRIGATION
OPTOKINETIC NYSTAGMUS TEST
CALORIC VESTIBULAR TEST WITH RECORDING, BILATERAL; BITHERMAL (IE, ONE WARM AND O
CALORIC VESTIBULAR TEST WITH RECORDING, BILATERAL; MONOTHERMAL (IE, ONE IRRIGATIO
VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRKG
SPONTANEOUS NYSTAGMUS TEST, W/GAZE AND FIXATION NY
POSITIONAL NYSTAGMUS TEST, MINIMUM, 4 POSITIONS, W
CALORIC VESTIBULAR TEST, EACH IRRIGATION, W/RECORD
OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL, FOVEAL/
OSCILLATING TRACKING TEST, W/RECORDING
SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING
USE, VERTICAL ELECTRODES
COMPUTERIZED DYNAMIC POSTUROGRAPHY
TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
SCREENING TEST, PURE TONE, AIR ONLY
PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY
PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE
SPEECH AUDIOMETRY THRESHOLD
SPEECH AUDIOMETRY THRESHOLD; W/SPEECH RECOGNITION
COMPREHENSIVE AUDIOMETRY THRESHOLD EVAL AND SPEECH
EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS
AUDIOMETRIC TESTING, GROUPS
BEKESY AUDIOMETRY; SCREENING
BEKESY AUDIOMETRY; DX
LOUDNESS BALANCE TEST, ALTERNATE BINAURAL/MONAURAL
TONE DECAY TEST
SHORT INCREMENT SENSITIVITY INDEX (SISI)
STENGER TEST, PURE TONE
TYMPANOMETRY (IMPEDANCE TESTING)
ACOUSTIC REFLEX THRESHOLD
ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY
FILTERED SPEECH TEST
STAGGERED SPONDAIC WORD TEST
SENSORINEURAL ACUITY LEVEL TEST
SYNTHETIC SENTENCE ID TEST
STENGER TEST, SPEECH
VISUAL REINFORCEMENT AUDIOMETRY (VRA)
CONDITIONING PLAY AUDIOMETRY
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
92583
92584
92585
92586
92587
92588
92590
92591
92592
92593
92594
92595
92596
92597
92601
92602
92603
92604
92605
92606
92607
92608
92609
92610
92611
92612
92613
92614
92615
92616
92617
92618
92620
92621
92625
92626
92627
92630
92633
92640
92700
92920
92921
92924
92925
92928
92929
92933
92934
92937
92938
92941
92943
92944
92950
92953
92960
92961
92970
92971
92973
92974
92975
92977
92978
92979
92986
92987
92990
92992
92993
92997
92998
93000
93005
93010
93015
93016
93017
93018
93024
93025
93040
93041
93042
93050
93224
93225
93226
93227
93228
SELECT PICTURE AUDIOMETRY
ELECTROCOCHLEOGRAPHY
AUDITORY EVOKED POTENTIALS, EVOKED RESPONSE AUDIOM
AUDITORY EVOKED POTENTIALS, EVOKED RESPONSE AUDIOM
DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
HEARING AID EXAM AND SELECTION; MONAURAL
HEARING AID EXAM AND SELECTION; BINAURAL
HEARING AID CHECK; MONAURAL
HEARING AID CHECK; BINAURAL
ELECTROACOUSTIC EVALUATION, HEARING AID; MONAURAL
ELECTROACOUSTIC EVALUATION, HEARING AID; BINAURAL
EAR PROTECTOR ATTENUATION MEASUREMENTS
EVAL FOR USE AND/OR FITTING VOICE PROSTHETIC DEVIC
DX ANALYSIS COCHLEAR IMPLANT, PATIENT UNDER 7 YRS;
DX ANALYSIS COCHLEAR IMPLANT, PATIENT UNDER 7 YRS;
DX ANALYSIS COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER
DX ANALYSIS COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; SUBSEQUENT REPROGRAMMING
EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR
THERAPEUTIC SERVICE(S), USE NON-SPEECH GENERATIING
EVAL, PRESCRIPTION, SPEECH-GENERATING AUGMENTATIVE
EVAL, PRESCRIP, SPEECH-GENERATING AUGMENTATIVE AND
THERAPEUTIC SERVICES, NON-SPEECH GENERATIVE DEVICE
EVAL, ORAL AND PHARYNGEAL SWALLOW FUNCTION
MOTION FLUOROSCOPIC EVAL, SWALLOW FUNCTION, CINE/V
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVAL, SWALLOW, CINE
FLX FIBOPT NDSC EVAL SWLNG C/V REC PHYS I&R
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVAL, LARYNGEAL SEN
FLX FIBOPT NDSC EVAL LARYN SENS PHYS I&R
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVAL, SWALLOWING AN
FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS PHYS I&R
EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV ADD 30 MIN
EVALUATION OF CENTRAL AUDITORY FUNCTION, INITIAL 6
EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
ASSESSMENT OF TINNITUS
EVAL OF AUDITORY REHABILITATION STATUS; FIRST HOUR
EVAL OF AUDITORY REHABILITATION STATUS; EACH ADD'L
AUDITORY REHABILITATION; PRE-LINGUAL HEARING LOSS
AUDITORY REHABILITATION; POST-LINGUAL HEARING LOSS
Aud brainstem implt programg
UNLISTED OTORHINOLARYNGOLOGICAL SERVICE/PROCEDURE
PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH
PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH
PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH
PRQ TRLUML CORONARY ANGIO/ATHEREC ADDL ART/BRNCH
PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH
PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH
PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH
PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH
PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL
PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL
PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL
PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL
PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL
CARDIOPULMONARY RESUSCITATION
TEMPORARY TRANSCUTANEOUS PACING
CARDIOVERSION, ELECTIVE; EXTERNAL
CARDIOVERSION, ELECTIVE; INTERNAL (SEP PROC)
CARDIOASSIST-METHOD, CIRCULATORY ASSIST; INTERNAL
CARDIOASSIST-METHOD, CIRCULATORY ASSIST; EXTERNAL
PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY
TRANSCATHETER PLACEMENT, RADIATION DELIVERY DEVICE
THROMBOLYSIS, CORONARY; INTRACORONARY INFUSION, W/
THROMBOLYSIS, CORONARY; IV INFUSION
INTRAVASCULAR ULTRASOUND, CORONARY VESSEL, DX/THER
INTRAVASCULAR ULTRASOUND, CORONARY VESSEL, DX/THER
PERCUTANEOUS BALLOON VALVULOPLASTY; AORTIC VALVE
PERCUTANEOUS BALLOON VALVULOPLASTY; MITRAL VALVE
PERCUTANEOUS BALLOON VALVULOPLASTY; PULMONARY VALV
ATRIAL SEPTECTOMY/SEPTOSTOMY; TRANSVENOUS BALLOON,
ATRIAL SEPTECTOMY/SEPTOSTOMY; BLADE METHOD W/CARDI
PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON
PERCUTANEOUS TRANSLUMINAL PULMONARY ANGIOPLASTY; A
ELECTROCARDIOGRAM, ROUTINE W/AT LEAST 12 LEADS; W/
ELECTROCARDIOGRAM, ROUTINE W/AT LEAST 12 LEADS; T
ELECTROCARDIOGRAM, ROUTINE W/AT LEAST 12 LEADS; IN
CV STRS TST XERS&/OR RX CONT ECG W/SI&R
CV STRS TST XERS&/OR RX CONT ECG W/O I&R
CARDIOVASCULAR STRESS TEST W/ECG MONITOR; TRACING
CARDIOVASCULAR STRESS TEST W/ECG MONITOR; INTERPRE
ERGONOVINE PROVOCATION TEST
MICROVOLT T-WAVE ALTERNANS, ASSESSMENT, VENTRICULA
RHYTHM ECG, 1-3 LEADS; W/INTERPRETATION AND REPORT
RHYTHM ECG, 1-3 LEADS; TRACING ONLY W/O INTERPRETA
RHYTHM ECG, 1-3 LEADS; INTERPRETATION AND REPORT O
ARTERIAL PRESSURE WAVEFORM ANALYSIS FOR ASSESSMENT OF CENTRAL ARTERIAL PRESSUR
XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I
XTRNL ECG UP TO 48 HR RECORDING
EXTERNAL ECG SCANNING ANALYSIS REPORT
XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS
XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2005
1/1/2005
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2007
1/1/2004
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
N
N
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
93229
93260
93261
93268
93270
93271
93272
93278
93279
93280
93281
93282
93283
93284
93285
93286
93287
93288
93289
93290
93291
93292
93293
93294
93295
93296
93297
93298
93299
93303
93304
93306
93307
93308
93312
93313
93314
93315
93316
93317
93318
93320
93321
93325
93350
93351
93352
93355
93451
93452
93453
93454
93455
93456
93457
93458
93459
93460
93461
93462
93463
93464
93503
93505
93530
93531
93532
93533
93561
93562
93563
93564
93565
93566
93567
93568
93571
93572
93580
93581
93582
93583
93600
93602
93603
93609
93610
93612
93613
93615
93616
XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT
PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM
INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB
XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS
XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
SIGNAL-AVERAGED ELECTROCARDIOGRAPHY (SAECG), W/WO
PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER
PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB
PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB
PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM
PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM
PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB
INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM
INTERROGATION EVAL F2F 1/DUAL/MLT LEADS CVDFB
INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS
INTERROGATION EVALUATION IN PERSON ILR SYSTEM
INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR
TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM
INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD DFB
INTERROGATION REMOTE </90 D TECHNICIAN REVIEW
INTERROGATION EVAL REMOTE </30 D CV MNTR SYS
INTERROGATION EVALUATION REMOTE </30 D ILR SYS
INTERROGATION EVAL REMOTE </30 D TECH REVIEW
TRANSTHORACIC ECHOCARDIOGRAPHY, CONGENITAL CARDIAC
TRANSTHORACIC ECHOCARDIOGRAPHY, CONGENITAL CARDIAC
ECHO TTHRC R-T 2D -+M-MODE COMPL SPEC&COLOR DOP
ECHOCARDIOGRAPHY, TRANSTHORACIC, 2D, W/WO M-MODE;
ECHOCARDIOGRAPHY, TRANSTHORACIC, 2D, W/WO M-MODE;
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, 2D; W/PROBE, IM
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, 2D;TRANSESOPHAG
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, 2D; IMAGE ACQUI
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, CONGENITAL ANOM
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, CONGENITAL ANOM
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, CONGENITAL ANOM
TEE FOR MONITORING, W/PROBE, REAL TIME 2D ACQUIS A
DOPPLER ECHOCARDIOGRAPHY; COMPLETE
DOPPLER ECHOCARDIOGRAPHY; FOLLOW-UP/LIMITED
DOPPLER COLOR FLOW MAPPING
ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME 2D, CAR
ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG
USE OF ECHO CONTRAST AGENT DURING STRESS ECHO
ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
CATH PLMT & NJX CORONARY ART ANGIO IMG S&I
CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
CATH PLMT R HRT/ARTS/GRFTS W/NJX&ANGIO IMG S&I
CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
R & L HRT CATH WINJX HRT ART& L VENTR IMG S&I
R&L HRT CATH W/INJEC HRT ART/GRFT&L VENT IMG S&I
LEFT HEART CATH BY TRANSEPTAL PUNCTURE
MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASURE
INSERTION AND PLACEMENT, FLOW DIRECTED CATHETER, M
ENDOMYOCARDIAL BX
RIGHT HEART CATHETERIZATION, CONGENITAL CARDIAC AN
COMBINED RIGHT/RETROGRADE LEFT HEART CATHETERIZATI
COMBINED RIGHT/TRANSSEPTAL LEFT HEART CATHETERIZAT
COMBINED RIGHT/TRANSSEPTAL LEFT HEART CATHETERIZAT
INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS
INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEAS
NJX SEL HRT ART CONGENITAL HRT CATH W/S&I
NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I
NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I
NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I
NJX SUPRAVALV AORTOG HRT CATH W/S&I
NJX PULMONARY ANGIO HRT CATH W/S&I
INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE COR
INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE COR
PERC TRANSCATHETER CLOSURE, CONGENITAL INTERATRIAL
PERC TRANSCATHETER CLOSURE, CONGENITAL VENTRICULAR
PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS
PERCUTANEOUS TRANSCATHETER SEPTAL REDUCTION THER
BUNDLE OF HIS RECORDING
INTRA-ATRIAL RECORDING
RIGHT VENTRICULAR RECORDING
INTRAVENTRICULAR AND/OR INTRA-ATRIAL MAPPING, TACH
INTRA-ATRIAL PACING
INTRAVENTRICULAR PACING
INTRACARDIAC ELECTROPHYSIOLOGIC 3-DIMENSIONAL MAPP
ESOPHAGEAL RECORDING, ATRIAL ELECTROGRAM W/WO VENT
ESOPHAGEAL RECORDING, ATRIAL ELECTROGRAM, W/WO VEN
1/1/2009
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2015
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
OUTPT ASC 13X AND 83X & POS 22 OR 24
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
All POS except 21, 23 & 51
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
93618
93619
93620
93621
93622
93623
93624
93631
93640
93641
93642
93644
93650
93653
93654
93655
93656
93657
93660
93662
93668
93701
93702
93724
93740
93745
93750
93770
93784
93786
93788
93790
93797
93798
93799
93880
93882
93886
93888
93890
93892
93893
93895
93922
93923
93924
93925
93926
93930
93931
93965
93970
93971
93975
93976
93978
93979
93980
93981
93982
93990
93998
94002
94003
94004
94005
94010
94011
94012
94013
94014
94015
94016
94060
94070
94150
94200
94250
94375
94400
94450
94452
94453
94610
94620
94621
94640
94642
94644
94645
94660
INDUCTION, ARRHYTHMIA, ELECTRICAL PACING
ELECTROPHYS EVAL, W/RIGHT ATRIAL/VENTRICULAR PACE/
ELECTROPHYS EVAL, INSERT CATH, W/ARRHYTHMIA INDUCT
ELECTROPHYS EVAL, INSERT CATH, W/ARRHYTHMIA INDUCT
ELECTROPHYS EVAL, INSERT CATH, W/ARRYTHMIA INDUCTI
PROGRAMMED STIMULATION AND PACING AFTER IV DRUG
ELECTROPHYS, FOLLOW-UP STUDY W/PACING AND RECORDIN
ELECTROPHYS, INTRA-OPERATIVE EPICARDIAL/ENDOCARDIA
ELECTROPHYS EVAL, SINGLE/DUAL PACING CARDIO/DEFIB
ELECTROPHYS EVAL, SINGLE/DUAL PACING CARDIO/DEFIB
EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS
EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR
INTRACARDIAC CATHETER ABLATION, ATRIOVENTRICULAR N
EPHYS EVAL W/ ABLATION SUPRAVENT ARRHYTHMIA
EPHYS EVAL W/ABLATION VENTRICULAR TACHYCARDIA
ICAR CATHETER ABLATION ARRHYTHMIA ADD ON
EPHYS EVL TRNSPTL TX ATRIAL FIB ISOLAT PULM VEIN
ABLATE L/R ATRIAL FIBRIL W/ ISOLATED PULM VEIN
CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE/CONTINUO
ECHOCARDIOGRAPHY, INTRACARDIAC, DURING DX/THERAPEU
PERIPHERAL ARTERIAL DISEASE VASCULAR REHABILITATIO
BIOIMPEDANCE CV ANALYSIS
BIS EXTRACELLULAR FLUID ALYS LYMPHEDEMA ASSMNT
ELECTRONIC ANALYSIS, PACEMAKER, ANTITACHYCARDIA
TEMPERATURE GRADIENT STUDIES
1ST SET-UP & PRGRMG PHYS/QHP OF WEARABLE CVDFB
INTERROGATION VAD IN PRSON W/PHYS/QHP ANALYSIS
DETERMINATION, VENOUS PRESSURE
AMBULATORY BP, OVER 24 HR, MONITORING; W/RECORDING
AMBULATORY BP, OVER 24 HR, MONITORING; RECORDING O
AMBULATORY BP, OVER 24 HR, MONITORING; SCAN ANALYS
AMBL BLD PRESS TAPE&/DISK 24/> HR REVIEW
OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR
OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING
UNLISTED CARDIOVASCULAR SERVICE/PROC
DUPLEX SCAN, EXTRACRANIAL ARTERIES; COMPLETE BILAT
DUPLEX SCAN, EXTRACRANIAL ARTERIES; UNILAT/LIMITED
TRANSCRANIAL DOPPLER STUDY, INTRACRANIAL ARTERIES;
TRANSCRANIAL DOPPLER STUDY, INTRACRANIAL ARTERIES;
TRANSCRANIAL DOPPLER STUDY, VASOREACTIVITY STUDY
TRANSCRANIAL DOPPLER STUDY, EMBOLI DETECTION WITHO
TRANSCRANIAL DOPPLER STUDY, EMBOLI DETECTION WITH
CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI
NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL
NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS
N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI
DUPLEX SCAN, LOWER EXTREMITY ARTERIES/ARTERIAL BYP
DUPLEX SCAN, LOWER EXTREMITY ARTERIES/ARTERIAL BYP
DUPLEX SCAN, UPPER EXTREMITY ARTERIES/ARTERIAL BYP
DUPLEX SCAN, UPPER EXTREMITY ARTERIES/ARTERIAL BYP
NON-INVASIVE VEIN STUDY, EXTREMITY, COMPLETE BILAT
DUPLEX SCAN, VEINS, EXTREMITY; COMPLETE BILAT STUD
DUPLEX SCAN, VEINS, EXTREMITY; UNILAT/LIMITED STUD
DUPLEX SCAN, ARTERIAL INFLOW, VENOUS OUTFLOW, ABDO
DUPLEX SCAN, ARTERIAL INFLOW, VENOUS OUTFLOW, ABDO
DUPLEX SCAN, AORTA, INFERIOR VENA CAVA, ILIAC VASC
DUPLEX SCAN, AORTA, INFERIOR VENA CAVA, ILIAC VASC
DUPLEX SCAN, ARTERIAL INFLOW AND VENOUS OUTFLOW, P
DUPLEX SCAN, ARTERIAL INFLOW AND VENOUS OUTFLOW, P
NONINV PHYS STDY IMPL WIRELSS PRESS SNSR ANEURYSM
DUPLEX SCAN, HEMODIALYSIS ACCESS
UNLISTED NONINVASIVE VASCULAR DIAGNOSTIC STUDY
Vent mgmt inpat, init day
Vent mgmt inpat, subq day
Vent mgmt nf per day
Home vent mgmt supervision
SPIROMETRY W/GRAPHIC RECORD/VITAL CAPACITY/FLOW RA
MEAS SPIROMTRC FORCD EXPIRATORY FLO INFANT-2 YR
MEAS SPIRO FORCD EXP FLO PRE&POST BRONCH INF-2Y
MEAS LUNG VOLUMES INFANT OR CHILD THRU 2 YRS
PT-INITIATE SPIROMETRIC RECORDING PHYS/QHP R&I
SPIROMETRIC RECORDING, PATIENT INITIATED, 30 DAY P
PATIENT-INITIATED SPIROMETRIC PHYS/QHP R&I ONLY
SPIROMETRY, EVAL BRONCHOSPASM, BEFORE/AFTER BRONCH
SPIROMETRY, EVAL BRONCHOSPASM, PROLONGED POSTEXPOS
VITAL CAPACITY, TOTAL (SEP PROC)
MAXIMUM BREATHING CAPACITY, MAXIMAL VOLUNTARY VENT
EXPIRED GAS COLLECTION, QUANTITATIVE, SINGLE PROC
RESPIRATORY FLOW VOLUME LOOP
BREATHING RESPONSE TO CO2 (CO2 RESPONSE CURVE)
BREATHING RESPONSE TO HYPOXIA (HYPOXIA RESPONSE CU
HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT
HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION
INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP
PULMONARY STRESS TESTING; SIMPLE
PULMONARY STRESS TESTING; COMPLEX
PRESSURIZED/NONPRESSURIZED INHALATION RX, AIRWAY O
AEROSOL INHALATION, PENTAMIDINE, PNEUMOCYSTIS CARI
Cbt, 1st hour
Cbt, each addl hour
CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (C
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2004
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2015
1/1/2004
1/1/2004
1/1/2005
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2005
1/1/2005
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2012
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2010
1/1/2010
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2005
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
94662
94664
94667
94668
94669
94680
94681
94690
94726
94727
94728
94729
94750
94760
94761
94762
94770
94772
94774
94775
94776
94777
94780
94781
94799
95004
95012
95017
95018
95024
95027
95028
95044
95052
95056
95060
95065
95070
95071
95076
95079
95115
95117
95120
95125
95130
95131
95132
95133
95134
95144
95145
95146
95147
95148
95149
95165
95170
95180
95199
95250
95251
95782
95783
95800
95801
95803
95805
95806
95807
95808
95810
95811
95812
95813
95816
95819
95822
95824
95827
95829
95830
95831
95832
95833
95834
95851
95852
95857
95860
95861
CONTINUOUS NEGATIVE PRESSURE VENTILATION (CNP), IN
DEMONSTRATE AND/OR EVAL, PT USE, AEROSOL GENERATOR
CHEST WALL MANIPULATION, FACILITATE LUNG FUNCTION;
CHEST WALL MANIPULATION, FACILITATE LUNG FUNCTION;
MECHANICAL CHEST WALL OSCILLATION LUNG FUNCTION
OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST AND EXER
OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; W/CO2 OUTPUT,
OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST, INDIREC
PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST
GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL
AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY
C02/MEMBANE DIFFUSE CAPACITY
PULMONARY COMPLIANCE STUDY
NONINVASIVE EAR/PULSE OXIMETRY, OXYGEN SATURATION;
NONINVASIVE EAR/PULSE OXIMETRY, OXYGEN SATURATION;
NONINVASIVE EAR/PULSE OXIMETRY, OXYGEN SATURATION;
CARBON DIOXIDE, EXPIRED GAS DETERMINATION, INFRARE
CIRCADIAN RESPIRATORY PATTERN RECORDING, 12-24 HR
PEDIATRIC APNEA MONITOR ATTACHMENT PHYS I&R
Ped home apnea rec, hk-up
Ped home apnea rec, downld
PEDIATRIC APNEA MONITOR PHYS/QHP REVIEW
CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN
CAR SEAT/BED TESTNG W/INTERP & REPORT +30MIN
UNLISTED PULMONARY SERVICE/PROC
PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS
Exhaled nitric oxide meas
ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R
ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R
INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS
INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE
ALLERGY TESTS, INTRADERMAL, ALLERGENIC EXTRACTS, D
PATCH/APPLICATION TEST(S) (SPECIFY NUMBER)
PHOTO PATCH TEST(S) (SPECIFY NUMBER)
PHOTO TESTS
OPHTHALMIC MUCOUS MEMBRANE TESTS
DIRECT NASAL MUCOUS MEMBRANE TEST
INHALATION BRONCHIAL CHALLENGE TESTS; W/HISTAMINE/
INHALATION BRONCHIAL CHALLENGE TESTS; W/ANTIGENS/G
INGESTION CHALLENGE TEST INITIAL 120 MINUTES
INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVI
PROFESSIONAL SVC, ALLERGEN IMMUNOTHERAPY NON-PROVI
PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX
PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX
PROF SVCS ALLG IMMNTX W/PRV XTRC 1 STING INSECT
PROF SVCS ALLG IMMNTX W/PRV XTRC 2 STING INSECT
PROF SVCS ALLG IMMNTX W/PRV XTRC 3 STING INSECT
PROF SVCS ALLG IMMNTX W/PRV XTRC 4 STING INSECT
PROF SVCS ALLG IMMNTX W/PRV XTRC 5 STING INSECT
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGEN,
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGEN,
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS
PROFESSIONAL SVC, SUPERVISION, PROVISION, ANTIGENS
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS
PROFES SVC, SUPERVIS, PREPARA, PROVISION, ANTIGENS
RAPID DESENSITIZATION PROC, EACH HOUR
UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SERVICE/PROC
GLUCOSE MONITORING, 72 HRS, CONT REC AND STORAGE,
AMBULATORY CONT GLUCOSE MONITORING ; UP TO 72 HOUR
POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND
POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM
SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL
ACTIGRAPHY TESTING RECORDING ANALYSIS I&R
MULTIPLE SLEEP LATENCY TEST, MULTIPLE TRAILS
SLEEP STUDY, UNATTENDED
SLEEP STUDY, ATTENDED
POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND
POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; 41
ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; OV
ELECTROENCEPHALOGRAM (EEG); W/AWAKE AND DROWSY REC
ELECTROENCEPHALOGRAM (EEG); W/AWAKE AND ASLEEP REC
ELECTROENCEPHALOGRAM (EEG); COMA/SLEEP RECORD ONLY
ELECTROENCEPHALOGRAM (EEG); CEREBRAL DEATH EVALUAT
ELECTROENCEPHALOGRAM (EEG); ALL NIGHT RECORD
ELECTROCORTICOGRAM AT SURGERY (SEP PROC)
INSERTION SPHENOIDAL ELECTRODES EEG PHYS/QHP
MUSCLE TESTING, MANUAL (SEP PROC) W/REPORT; EXTREM
MUSCLE TESTING, MANUAL (SEP PROC) W/REPORT; HAND,
MUSCLE TESTING, MANUAL (SEP PROC) W/REPORT; TOTAL
MUSCLE TESTING, MANUAL (SEP PROC) W/REPORT; TOTAL
RANGE, MOTION MEASUREMENTS AND REPORT; EACH EXTREM
RANGE, MOTION MEASUREMENTS AND REPORT; HAND, W/WO
CHOLINESTERASE INHIBITOR CHALLENGE TEST
EMG, NEEDLE; 1 EXTREMITY W/WO RELATED PARASPINAL A
EMG, NEEDLE; 2 EXTREMITIES W/WO RELATED PARASPINAL
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2007
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2013
1/1/2013
1/1/2011
1/1/2011
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
95863
95864
95865
95866
95867
95868
95869
95870
95872
95873
95874
95875
95885
95886
95887
95905
95907
95908
95909
95910
95911
95912
95913
95921
95922
95923
95924
95925
95926
95927
95928
95929
95930
95933
95937
95938
95939
95940
95941
95943
95950
95951
95953
95954
95955
95956
95957
95958
95961
95962
95965
95966
95967
95970
95971
95972
95973
95974
95975
95978
95979
95980
95981
95982
95990
95991
95992
95999
96000
96001
96002
96003
96004
96020
96040
96101
96102
96103
96105
96110
96111
96116
96118
96119
96120
96125
96127
96150
96151
96152
96153
EMG, NEEDLE; 3 EXTREMITIES W/WO RELATED PARASPINAL
EMG, NEEDLE; 4 EXTREMITIES W/WO RELATED PARASPINAL
NEEDLE ELECTROMYOGRAPHY; LARYNX
NEEDLE ELECTROMYOGRAPHY; HEMIDIAPHRAGM
EMG, NEEDLE; CRANIAL NERVE SUPPLIED MUSCLE(S), UNI
EMG, NEEDLE; CRANIAL NERVE SUPPLIED MUSCLES, BILAT
EMG, NEEDLE; THORACIC PARASPINAL MUSCLES, EXCLUDIN
EMG, NEEDLE; 1 EXTREMITY/NON-LIMB (UNILAT/BILAT),
EMG, NEEDLE, 1 FIBER ELECTRODE W/QUANTITATIVE MEAS
ELECTRICAL STIMULATION FOR GUIDANCE IN CONJUNCTION
NEEDLE ELECTROMYOGRAPHY FOR GUIDANCE IN CONJUNCTIO
ISCHEMIC LIMB EXERCISE W/SERIAL SPECIMEN(S) ACQUIS
NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED
NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE
NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION
MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
NERVE CONDUCTION STUDIES 1-2 STUDIES
NERVE CONDUCTION STUDIES 3-4 STUDIES
NERVE CONDUCTION STUDIES 5-6 STUDIES
NERVE CONDUCTION STUDIES 7-8 STUDIES
NERVE CONDUCTION STUDIES 9-10 STUDIES
NERVE CONDUCTION STUDIES 11-12 STUDIES
NERVE CONDUCTION STUDIES 13/> STUDIES
TESTING, AUTONOMIC NERVOUS SYSTEM; CARDIOVAGAL INN
TESTING, AUTONOMIC NERVOUS SYSTEM; SYMPATHETIC ADR
TESTING, AUTONOMIC NERVOUS SYSTEM; SUDOMOTOR
TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT
SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY
SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY
SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY
CENTRAL MOTOR EVOKED POTENTIAL STUDY, UPPER LIMBS
CENTRAL MOTOR EVOKED POTENTIAL STUDY, LOWER LIMBS
VISUAL EVOKED POTENTIAL (VEP) TESTING CENTRAL NERV
ORBICULARIS OCULI REFLEX, BY ELECTRODX TESTING
NEUROMUSCULAR JUNCTION TEST, EACH NERVE, ANY ONE M
SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMBS
CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LIMB
IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES
IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR
PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY
MONITORING, ID AND LATERALIZATION, CEREBRAL SEIZUR
MONITORING, LOCALIZATION, CEREBRAL SEIZURE FOCUS,
LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG
RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE
ELECTROENCEPHALOGRAM (EEG) DURING NONINTRACRANIAL
MNTR SEIZURE CMPTR 16>CHAN EEG ATND EA 24 HR
DIGITAL ANALYSIS, ELECTROENCEPHALOGRAM (EEG)
WADA ACTIVATION TEST, HEMISPHERIC FUNCTION, W/EEG
FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR
MAGNETOENCEPHALOGRAPHY (MEG), RECORD AND ANALYSIS;
MAGNETOENCEPHALOGRAPHY (MEG), RECORD AND ANALYSIS;
MAGNETOENCEPHALOGRAPHY (MEG), RECORD AND ANALYSIS;
ELECTRONIC ANALYSIS, IMPLANT NEUUROSTIMULATOR; SIM
ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG
ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR
ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH EA 30 MIN
ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR
ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV EA 30 MIN
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR P
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR P
ELEC ALYS NSTIM PLS GEN GASTRIC INTRAOP W/PRGRMG
ELEC ALYS NSTIM GEN GASTRIC SBSQ W/O REPRGRMG
ELEC ALYS NSTIM PLS GEN GASTRIC SBSQ W/REPRGRMG
REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN
RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP
CANALITH REPOSITIONING PROCEDURE
UNLISTED NEUROLOGICAL/NEUROMUSCULAR DX PROC
COMPREHENSIVE COMPUTER-BASED MOTION ANALYSIS BY VI
COMPREHENSIVE COMPUTER-BASED MOTION ANAL; W/DYNAMI
DYNAMIC SURFACE ELECTROMYOGRAPHY, WALKING/FUNCTION
DYNAMIC FINE WIRE ELECTROMYOGRAPHY, WALKING/FUNCTI
PHYS/QHP R&I CPTR MTN ALYS WALK/FUNCJL ACTV REPR
TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP
Genetic counseling, 30 min
PSYCHOLOGICAL TESTING; PER HR FOR PSYCHOLOGIST OR
PSYCHOLOGICAL TESTING; PER HR FOR TECHNICIAN TIME
PSYCHOLOGICAL TESTING; ADMINISTRATED BY COMPUTER
ASSESSMENT, APHASIA, INTERPRETATION AND REPORT, PE
DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
DEVELOPMENTAL TESTING; EXTENDED, W/INTERPRETATION
NEUROBEHAVIORAL STATUS EXAM; PER HOUR OF PHYS OR P
NEUROPSYCHOLOGICAL TESTING; PER HOUR OF PHYS OR PS
NEUROPSYCHOLOGICAL TESTING; PER HOUR OF TECHNICIAN
NEUROPSYCHOLOGICAL TESTING; ADMINISTERED BY A COMP
STANDARDIZED COGNITIVE PERFORMANCE TESTING
BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
HEALTH AND BEHAVIOR ASSESSMENT, EA 15 MINUTES; INI
HEALTH AND BEHAVIOR ASSESSMENT, EA 15 MINUTES; REHEALTH AND BEHAVIOR INTERVENTION, EA 15 MINUTES; I
HEALTH AND BEHAVIOR INTERVENTION, EA 15 MINUTES; G
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2012
1/1/2012
1/1/2012
1/1/2010
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2005
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2008
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
96154
96155
96360
96361
96365
96366
96367
96368
96369
96370
96371
96372
96373
96374
96375
96376
96379
96401
96402
96405
96406
96409
96411
96413
96415
96416
96417
96420
96422
96423
96425
96440
96446
96450
96521
96522
96523
96542
96549
96567
96570
96571
96900
96902
96904
96910
96912
96913
96920
96921
96922
96931
96932
96933
96934
96935
96936
96999
97001
97002
97003
97004
97005
97006
97010
97012
97014
97016
97018
97022
97024
97026
97028
97032
97033
97034
97035
97036
97039
97110
97112
97113
97116
97124
97139
97140
97150
97530
97532
97533
97535
HEALTH AND BEHAVIOR INTERVENTION, EA 15 MINUTES; F
HEALTH AND BEHAVIOR INTERVENTION, EA 15 MINUTES; F
IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR
IV INFUSION HYDRATION EACH ADDITIONAL HOUR
IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST >1 HOUR
IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR
IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR
IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS
SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP
SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR
SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE
THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM
THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL
THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG
THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG
SUBCUTANEOUS INFUSION EACH ADDITIONAL IV PUSH
UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS
CHEMOTHERAPY ADMINISTRATION, SUBQ/IM, NON-HORMONAL
CHEMOTHERAPY ADMINISTRATION, SUBQ/IM, HORMONAL ANT
CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL; UP TO
CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL; GREATE
CHEMOTHERAPY ADMINISTRATION, IV; PUSH TECHNIQUE; I
CHEMOTHERAPY ADMINISTRATION, IV; PUSH TECHNIQUE; E
CHEMOTHERAPY, IV; INFUSION, UP TO 1 HR; SINGLE/INI
CHEMOTHERAPY, IV; INFUSION, EACH ADD'L HR; 1-8 HR
CHEMOTHERAPY, IV; INFUSION, INITIATION OF PROLONGE
CHEMOTHERAPY, IV; INFUSION, EACH SEQUENTIAL INFUSI
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; PUSH
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUS
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUS
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUS
CHEMOTHERAPY ADMINISTRATION INTO PLEURAL CAVITY, R
CHEMOTX ADMN PRTL CAVITY PORT/CATH
CHEMOTHERAPY ADMINISTRATION, CNS, REQUIRING, W/LUM
REFILLING AND MAINTENANCE OF PORTABLE PUMP
REFILLING AND MAINTENANCE OF PORTABLE PUMP, SYSTEM
IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR D
CHEMOTHERAPY INJECTION, SUBARACHNOID/INTRAVENTRICU
UNLISTED CHEMOTHERAPY PROC
EXTERNAL PHOTODYNAMIC THERAPY, EACH PHOTOTHERAPY E
ENDOSCOPIC PHOTODYNAMIC THERAPY; 1ST 30 MIN
ENDOSCOPIC PHOTODYNAMIC THERAPY; EACH ADDL 15 MIN
ACTINOTHERAPY (ULTRAVIOLET LIGHT)
MICROSCOPIC EXAM, HAIR PLUCKED/CLIPPED, EXAMINER
Whole body photography
PHOTOCHEMOTHERAPY; TAR AND UVB/PETROLATUM AND UVB
PHOTOCHEMOTHERAPY; PSORALENS AND ULTRAVIOLET A (PU
PHOTOCHEMOTHERAPY, 4-8 HR, DIRECT SUPERVISION, PHY
LASER TX, INFLAMMATORY SKIN DISEASE (PSORIASIS); T
LASER TX, INFLAMMATORY SKIN DISEASE (PSORIASIS); 2
LASER TX, INFLAMMATORY SKIN DISEASE (PSORIASIS); G
REFLECTANCE CONFOCAL MICROSCOPY (RCM) FOR CELLULAR AND SUB-CELLULAR IMAGING O
REFLECTANCE CONFOCAL MICROSCOPY (RCM) FOR CELLULAR AND SUB-CELLULAR IMAGING O
REFLECTANCE CONFOCAL MICROSCOPY (RCM) FOR CELLULAR AND SUB-CELLULAR IMAGING O
REFLECTANCE CONFOCAL MICROSCOPY (RCM) FOR CELLULAR AND SUB-CELLULAR IMAGING O
REFLECTANCE CONFOCAL MICROSCOPY (RCM) FOR CELLULAR AND SUB-CELLULAR IMAGING O
REFLECTANCE CONFOCAL MICROSCOPY (RCM) FOR CELLULAR AND SUB-CELLULAR IMAGING O
UNLISTED SPECIAL DERMATOLOGICAL SERVICE/PROC
PHYSICAL THERAPY EVAL
PHYSICAL THERAPY RE-EVAL
OCCUPATIONAL THERAPY EVAL
OCCUPATIONAL THERAPY RE-EVAL
ATHLETIC TRAINING EVALUATION
ATHLETIC TRAINING RE-EVALUATION
APPLICATION, MODALITY TO 1 OR MORE AREAS; HOT/COLD
APPLICATION, MODALITY TO 1OR MORE AREAS; TRACTION,
APPLICATION, MODALITY TO 1OR MORE AREAS; ELECTRICA
APPLICATION, MODALITY TO 1OR MORE AREAS; VASOPNEUM
APPLICATION, MODALITY TO 1OR MORE AREAS; PARAFFIN
APPLICATION, MODALITY TO 1 OR MORE AREAS; WHIRLPOO
APPLICATION, MODALITY TO 1 OR MORE AREAS; DIATHERM
APPLICATION, MODALITY TO 1 OR MORE AREAS; INFRARED
APPLICATION, MODALITY TO 1 OR MORE AREAS; ULTRAVIO
APPLICATION, MODALITY TO 1 OR MORE AREAS; ELECTRIC
APPLICATION, MODALITY TO 1 OR MORE AREAS; IONTOPHO
APPLICATION, MODALITY TO 1 OR MORE AREAS; CONTRAST
APPLICATION, MODALITY TO 1 OR MORE AREAS; ULTRASOU
APPLICATION, MODALITY TO 1 OR MORE AREAS; HUBBARD
UNLISTED MODALITY (SPECIFY TYPE AND TIME IF CONSTA
THERAPEUTIC PROC, 1 OR MORE AREAS, EACH 15 MIN; TH
THERAPEUTIC PROC, 1 OR MORE AREAS, EACH 15 MIN; NE
THERAPEUTIC PROC, 1 OR MORE AREAS, EACH 15 MIN; AQ
THERAPEUTIC PROC, 1 OR MORE AREAS, EACH 15 MIN; GA
THERAPEUTIC PROC, 1 OR MORE AREAS, EACH 15 MIN; MA
UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
MANUAL THERAPY TECHNIQUES, 1 OR MORE REGIONS, EACH
THERAPEUTIC PROC(S), GROUP, (2 OR MORE INDIVIDUALS
THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN
DEVELOPMENT OF COGNITIVE SKILLS EACH 15 MINUTES
SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES
SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
Y
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
OUTPT ASC 13X AND 83X & POS 22 OR 24
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
97537
97542
97545
97546
97597
97598
97602
97605
97606
97607
97608
97610
97750
97755
97760
97761
97762
97799
97802
97803
97804
97810
97811
97813
97814
98925
98926
98927
98928
98929
98940
98941
98942
98943
98960
98961
98962
98966
98967
98968
98969
99000
99001
99002
99024
99026
99027
99050
99051
99053
99056
99058
99060
99070
99071
99075
99078
99080
99082
99090
99091
99100
99116
99135
99140
99143
99144
99145
99148
99149
99150
99170
99172
99173
99174
99175
99177
99183
99184
99188
99190
99191
99192
99195
99199
99201
99202
99203
99204
99205
99211
COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN
WHEELCHAIR MANAGEMENT/PROPULSION TRAIN, EACH 15 MI
WORK HARDENING/CONDITIONING; INITIAL 2 HOURS
WORK HARDENING/CONDITIONING; ADDL HR
DEBRIDEMENT OPEN WOUND 20 SQ CM<
DEBRIDEMENT OPEN WOUND ADDL 20 SQ CM
REMOVAL DEVITAL TISSUE, WOUND; NON-SELECTIVE DEBRI
NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM
NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM
NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM
NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM
LOW FREQUENCY NON-THERMAL ULTRASOUND PER DAY
PHYSICAL PERFORMANCE TEST, W/WRITTEN REPORT, EACH
ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN
ORTHOTIC MGMT AND TRAINING; EACH 15 MINUTES
PROSTHETIC TRAINING; UPPER AND/OR LOWER EXTREMITY;
CHECKOUT FOR ORTHOTIC/PROSTHETIC USE. ESTABLISHED
UNLISTED PHYSICAL MEDICINE/REHABILITATION SERVICE/
MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND
MEDICAL NUTRITION THERAPY; RE-ASSESSMENT AND INTER
MEDICAL NUTRITION THERAPY; GROUP (2 OR MORE IND),E
ACUPUNCTURE, WITHOUT ELECTRICAL STIMULATION, INITI
ACUPUNCTURE, WITHOUT ELECTRICAL STIMULATION, EACH
ACUPUNCTURE, WITH ELECTRICAL STIMULATION, INITIAL
ACUPUNCTURE, WITH ELECTRICAL STIMULATION, EACH ADD
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); 1-2 BODY
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); 3-4 BODY
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); 5-6 BODY
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); 7-8 BODY
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); 9-10 BOD
CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL,
CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL,
CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL,
CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASP
EDUCATION/TRAINING FOR PT SELF-MGMT ; EACH 30 MINU
EDUCATION/TRAINING FOR PT SELF-MGMT ; EACH 30 MINU
EDUCATION/TRAINING FOR PT SELF-MGMT ; EACH 30 MINU
NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN
NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN
NONPHYSICIAN ONLINE ASSESSMENT AND MANAGEMENT
HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB
HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB
HANDLE/CONVEY/ANY OTH SVC DEVICE FIT PHYS/QHP
POSTOPERATIVE FOLLOW-UP VISIT, INCLUDED SURGICAL P
HOSPITAL MANDATED ON CALL SERVICE; IN-HOSPITAL, EA
HOSPITAL MANDATED ON CALL SERVICE; OUT-OF-HOSPITAL
SERVICES AFTER POSTED OFFICE HOURS, AND BASIC SER
SERVICES PROVIDED IN THE OFFICE DURING REGULARLY S
Service provided between 10:00 pm and 8:00 am at
NON-OFFICE MEDICAL SERVICES, PATIENT REQUEST, NORM
OFFICE SERVICES, EMERGENCY BASIS
SERVICES PROVIDED ON AN EMERGENCY BASIS; IN ADDITI
SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP
EDUCATIONAL SUPPLIES PRV BY THE PHYS AT COST
MEDICAL TESTIMONY
PHYS/QHP EDUCATION SVCS RENDERED PTS GRP SETTING
SPECIAL REPORTS/INSURANCE FORMS
UNUSUAL TRAVEL
ANALYSIS, STORED COMPUTER CLINICAL/DATA
COLLJ&INTERPJ PHYS/QHP PHYSIO COMPUTR DATA 30 MI
ANESTHESIA, PATIENT, EXTREME AGE UNDER 1 YR, AND
ANESTHESIA W/HYPOTHERMIA
ANESTHESIA W/HYPOTENSION
ANESTHESIA, EMERGENCY CONDITIONS
MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN
MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN
MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN
MOD SEDATJ DIFF PHYS/QHP <5 YRS INIT 30 MIN
MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN
MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN
ANOGENITAL XM MAGNIFY CHILD/SUSPECT TRAUMA W IMG
VISUAL FUNCTION SCREENING, AUTOMATED, SEMI-AUTOMAT
SCREENING, VISUAL ACUITY, QUANTITATIVE, BILAT
INSTRUMENT BASED OCULAR SCREENING BILATERAL
INDUCTION, VOMITING, POISON
INSTRUMENT-BASED OCULAR SCREENING (EG, PHOTOSCREENING, AUTOMATED-REFRACTION)
PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX /SESSION
INITIAT SELECTIVE HEAD/BODY HYPOTHERMIA NEONATE
APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP
ASSEMBLY AND OPERATION, PUMP W/OXYGENATOR/HEAT EXC
ASSEMBLY AND OPERATION, PUMP W/OXYGENATOR/HEAT EXC
ASSEMBLY AND OPERATION, PUMP W/OXYGENATOR/HEAT EXC
PHLEBOTOMY, THERAPEUTIC (SEP PROC)
UNLISTED PROC, SPECIAL SERVICE/REPORT
OFFICE OUTPATIENT NEW 10 MINUTES
OFFICE OUTPATIENT NEW 20 MINUTES
OFFICE OUTPATIENT NEW 30 MINUTES
OFFICE OUTPATIENT NEW 45 MINUTES
OFFICE OUTPATIENT NEW 60 MINUTES
OFFICE OUTPATIENT VISIT 5 MINUTES
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2005
1/1/2004
1/1/2005
1/1/2005
1/1/2015
1/1/2015
1/1/2014
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2005
1/1/2005
1/1/2005
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2016
1/1/2004
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
Diagnosis validation
Diagnosis validation
Diagnosis validation
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
99212
99213
99214
99215
99217
99218
99219
99220
99221
99222
99223
99224
99225
99226
99231
99232
99233
99234
99235
99236
99238
99239
99241
99242
99243
99244
99245
99251
99252
99253
99254
99255
99281
99282
99283
99284
99285
99288
99291
99292
99304
99305
99306
99307
99308
99309
99310
99315
99316
99318
99324
99325
99326
99327
99328
99334
99335
99336
99337
99339
99340
99341
99342
99343
99344
99345
99347
99348
99349
99350
99354
99355
99356
99357
99358
99359
99360
99363
99364
99366
99367
99368
99374
99375
99377
99378
99379
99380
99381
99382
99383
OFFICE OUTPATIENT VISIT 10 MINUTES
OFFICE OUTPATIENT VISIT 15 MINUTES
OFFICE OUTPATIENT VISIT 25 MINUTES
OFFICE OUTPATIENT VISIT 40 MINUTES
OBSERVATION CARE DISCHARGE MANAGEMENT
INITIAL OBSERVATION CARE/DAY 30 MINUTES
INITIAL OBSERVATION CARE/DAY 50 MINUTES
INITIAL OBSERVATION CARE/DAY 70 MINUTES
INITIAL HOSPITAL CARE/DAY 30 MINUTES
INITIAL HOSPITAL CARE/DAY 50 MINUTES
INITIAL HOSPITAL CARE/DAY 70 MINUTES
SBSQ OBSERVATION CARE/DAY 15 MINUTES
SBSQ OBSERVATION CARE/DAY 25 MINUTES
SBSQ OBSERVATION CARE/DAY 35 MINUTES
SBSQ HOSPITAL CARE/DAY 15 MINUTES
SBSQ HOSPITAL CARE/DAY 25 MINUTES
SBSQ HOSPITAL CARE/DAY 35 MINUTES
OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES
OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES
OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES
HOSPITAL DISCHARGE DAY MANAGEMENT; UP TO 30 MIN
HOSPITAL DISCHARGE DAY MANAGEMENT; OVER 30 MIN
OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN
OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN
OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN
OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN
OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN
INITL INPATIENT CONSULT NEW/ESTAB PT 20 MIN
INITL INPATIENT CONSULT NEW/ESTAB PT 40 MIN
INITL INPATIENT CONSULT NEW/ESTAB PT 55 MIN
INITL INPATIENT CONSULT NEW/ESTAB PT 80 MIN
INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN
EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB
EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY
EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY
EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY
EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ
PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS
CRITICAL CARE, EVALUATION AND MANAGEMENT
CRITICAL CARE, EVALUATION AND MANAGEMENT, ADDL 30
INITIAL NURSING FACILITY CARE/DAY 25 MINUTES
INITIAL NURSING FACILITY CARE/DAY 35 MINUTES
INITIAL NURSING FACILITY CARE/DAY 45 MINUTES
SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN
SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN
SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN
SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN
NURSING FACILITY DISCHARGE DAY MANAGEMENT; 30 MIN
NURSING FACILITY DISCHARGE DAY MANAGEMENT; MORE TH
E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN
DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN
DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN
DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MINUTES
DOMICIL/REST HOME NEW PT VISIT HI SEVER 60 MIN
DOM/R-HOME E/M NEW PT SIGNIF NEW PROB 75 MINUTES
DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES
DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES
DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES
DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES
IND PHYSICIAN SUPERVISION OF A PATIENT IN HOME, DO
IND PHYSICIAN SUPERVISION OF A PATIENT IN HOME, DO
HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES
HOME VISIT NEW PATIENT MOD SEVERITY 30 MINUTES
HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES
HOME VISIT NEW PATIENT HI SEVERITY 60 MINUTES
HOME VISIT NEW PT UNSTABL/SIGNIF NEW PROB 75 MIN
HOME VISIT EST PT SELF LIMITED/MINOR 15 MINUTES
HOME VISIT EST PT LOW-MOD SEVERITY 25 MINUTES
HOME VISIT EST PT MOD-HI SEVERITY 40 MINUTES
HOME VST EST PT UNSTABLE/SIGNIF NEW PROB 60 MINS
PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR
PROLONGED PHYSICIAN SERVICE, OFFICE/OP W/DIRECT CO
PROLONGED PHYSICIAN SERVICE, INPT W/DIRECT CONTACT
PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN
PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR
PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MIN
PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES
Anticoag mgmt, init
Anticoag mgmt, subseq
TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN
TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN
TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN
SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES
SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>
SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN
SUPERVISION HOSPICE PATIENT/MONTH 30 MINUTES/>
SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN
SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE E AND M
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE E AND M
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE E AND M
1/1/2004
1/1/2004
1/1/2003
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
POS 22 or 23
POS 22 or 23
POS 22 or 23
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CUST
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
99384
99385
99386
99387
99391
99392
99393
99394
99395
99396
99397
99401
99402
99403
99404
99406
99407
99408
99409
99411
99412
99415
99416
99420
99429
99441
99442
99443
99444
99446
99447
99448
99449
99450
99455
99456
99460
99461
99462
99463
99464
99465
99466
99467
99468
99469
99471
99472
99475
99476
99477
99478
99479
99480
99485
99486
99487
99489
99490
99495
99496
99497
99498
99499
99500
99501
99502
99503
99504
99505
99506
99507
99509
99510
99511
99512
99600
99601
99602
99605
99606
99607
SS001
001
002
003
004
005
006
007
008
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE E AND M
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE E AND M
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE E AND M
INITIAL COMPREHENSIVE PREVENTIVE MEDICINE E AND M
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE E AND M
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE EANDM W
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE EANDM W
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE EANDM W
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE EANDM W
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE EANDM W
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE EANDM W
PREVENTIVE MEDICINE COUNSELING, INDIV; 15 MIN
PREVENTIVE MEDICINE COUNSELING, INDIV; 30 MIN
PREVENTIVE MEDICINE COUNSELING, INDIV; 45 MIN
PREVENTIVE MEDICINE COUNSELING, INDIV; 60 MIN
TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
TOBACCO USE CESSATION INTENSIVE >10 MINUTES
ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
ALCOHOL/SUBSTANCE SCREEN & INTERVEN >30 MIN
PREVENTIVE MEDICINE COUNSELING, GROUP; 30 MIN
PREVENTIVE MEDICINE COUNSELING, GROUP; 60 MIN
PROLONGED CLINICAL STAFF SERVICE (THE SERVICE BEYOND THE TYPICAL SERVICE TIME) DUR
PROLONGED CLINICAL STAFF SERVICE (THE SERVICE BEYOND THE TYPICAL SERVICE TIME) DUR
ADMINISTRATION AND INTERPRETATION HEALTH RISK ASSE
UNLISTED PREVENTIVE MEDICINE SERVICE
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
PHYS/QHP TELEPHONE EVALUATION 11-20 MIN
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
PHYS/QHP ONLINE EVALUATION & MANAGEMENT SERVICE
INTERPROF PHONE/INTERNET ASSESS/MANAGE 5-10
INTERPROF PHONE/INTERNET ASSESS/MANAGE 11-20
INTERPROF PHONE/INTERNET ASSESS/MANAGE 21-30
INTERPROF PHONE/INTERNET ASSESS/MANAGE31/>
BASIC LIFE/DISABILITY EXAM
WORK/MEDICAL DISABILITY EXAM, TREATING PHYSICIAN
WORK/MEDICAL DISABILITY EXAM, NON-TREATING PHYSICI
1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB
1ST CARE PR DAY NML NB XCPT HOSP/BIRTHING CENTER
SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
1ST HOSP/BIRTHING CENTER NB ADMIT&DSCHG SM DATE
ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
DELIVERY/BIRTHING ROOM RESUSCITATION
CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN
CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN
1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<
SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
INITIAL PED CRITICAL CARE 29 D THRU 24 MO
SUBSEQUENT PED CRITICAL CARE 29 D THRU 24 MO
INITIAL PED CRITICAL CARE 2 THRU 5 YEARS
SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS
INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL
SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS
SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS
SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS
SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN
SUPERVISION INTERFACILITY TRANSPORT ADDL 30 MIN
CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MO
CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH
CHRON CARE MANAGEMENT SRVC 20 MIN PER MONTH
TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE
TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE
ADVANCE CARE PLANNING FIRST 30 MINS
ADVANCE CARE PLANNING EA ADDL 30 MINS
UNLISTED EVALUATION AND MANAGEMENT SERVICE
HOME VISIT, PRENAT MONITOR ASSESS, FETAL HEART RAT
HOME VISIT, POSTNATAL ASSESSMENT, FOLLOW-UP CARE
HOME VISIT, NEWBORN CARE, ASSESSMENT
HOME VISIT, RESPIRATORY THERAPY CARE (BRONCHODILAT
HOME VISIT, MECHANICAL VENTILATION CARE
HOME VISIT, STOMA CARE AND MAINTENANCE, COLOSTOMY,
HOME VISIT, IM INJECTIONS
HOME VISIT, CARE AND MAINTENANCE CATHETER(S) (THER
HOME VISIT, ASSISTANCE W/ACTIVITIES DAILY LIVING A
HOME VISIT INDIVIDUAL, FAMILY, MARRIAGE COUNSELING
HOME VISIT, FECAL IMPACTION MANAGEMENT AND ENEMA A
HOME VISIT, HEMODIALYSIS
UNLISTED HOME VISIT SERVICE/PROCEDURE
HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, PER V
HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, PER V
MEDICATION THERAPY 1ST 15 MIN NEW PATIENT
MEDICATION THERAPY F2F 1ST 15 MIN ESTABLISHED PT
MEDICATION THERAPY F2F EA ADDITIONAL 15 MIN
SPECIAL SERVICES
Heart transplant or implant of heart assist system w MCC
Heart transplant or implant of heart assist system w/o MCC
ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj OR
Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj OR
Liver transplant w MCC or intestinal transplant
Liver transplant w/o MCC
Lung transplant
Simultaneous pancreas/kidney transplant
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2009
1/1/2008
1/1/2009
1/1/2009
1/1/2009
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2015
1/1/2013
1/1/2013
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2006
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
009
010
011
012
013
014
015
016
017
018
019
020
021
022
023
024
025
026
027
028
029
030
031
032
033
034
035
036
037
038
039
040
041
042
043
044
045
046
047
048
049
050
051
052
053
054
055
056
057
058
059
060
061
062
063
064
065
066
067
068
069
070
071
072
073
074
075
076
077
078
079
080
081
082
083
084
085
086
087
088
089
090
091
092
093
094
095
096
097
098
099
SPINAL DISORDERS AND INJURIES
Pancreas transplant
Tracheostomy for face,mouth & neck diagnoses w MCC
Tracheostomy for face,mouth & neck diagnoses w CC
Tracheostomy for face,mouth & neck diagnoses w/o CC/MCC
Allogeneic Bone Marrow Transplant
Autologous Bone Marrow Transplant
Autologous Bone Marrow Transplant W CC/MCC
Autologous Bone Marrow Transplant W/O CC/MCC
CRANIAL AND PERIPHERAL NERVE DISORDERS W CC
CRANIAL AND PERIPHERAL NERVE DISORDERS W/O CC
Intracranial vascular procedures w PDX hemorrhage w MCC
Intracranial vascular procedures w PDX hemorrhage w CC
Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC
Cranio w major dev impl/acute complex CNS PDX w MCC or chemo implant
Cranio w major dev impl/acute complex CNS PDX w/o MCC
Craniotomy & endovascular intracranial procedures w MCC
Craniotomy & endovascular intracranial procedures w CC
Craniotomy & endovascular intracranial procedures w/o CC/MCC
Spinal procedures w MCC
Spinal procedures w CC or spinal neurostimulators
Spinal procedures w/o CC/MCC
Ventricular shunt procedures w MCC
Ventricular shunt procedures w CC
Ventricular shunt procedures w/o CC/MCC
Carotid artery stent procedure w MCC
Carotid artery stent procedure w CC
Carotid artery stent procedure w/o CC/MCC
Extracranial procedures w MCC
Extracranial procedures w CC
Extracranial procedures w/o CC/MCC
Periph/cranial nerve & other nerv syst proc w MCC
Periph/cranial nerve & other nerv syst proc w CC or periph neurostim
Periph/cranial nerve & other nerv syst proc w/o CC/MCC
HYPHEMA
ACUTE MAJOR EYE INFECTIONS
Neurological eye disorders
OTHER DISORDERS OF THE EYE AGE >17 W CC
OTHER DISORDERS OF THE EYE AGE >17 W/O CC
OTHER DISORDERS OF THE EYE AGE 0-17
MAJOR HEAD AND NECK PROCEDURES
SIALOADENECTOMY
SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY
Spinal disorders & injuries w CC/MCC
Spinal disorders & injuries w/o CC/MCC
Nervous system neoplasms w MCC
Nervous system neoplasms w/o MCC
Degenerative nervous system disorders w MCC
Degenerative nervous system disorders w/o MCC
Multiple sclerosis & cerebellar ataxia w MCC
Multiple sclerosis & cerebellar ataxia w CC
Multiple sclerosis & cerebellar ataxia w/o CC/MCC
Acute ischemic stroke w use of thrombolytic agent w MCC
Acute ischemic stroke w use of thrombolytic agent w CC
Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC
Intracranial hemorrhage or cerebral infarction w MCC
Intracranial hemorrhage or cerebral infarction w CC
Intracranial hemorrhage or cerebral infarction w/o CC/MCC
Nonspecific cva & precerebral occlusion w/o infarct w MCC
Nonspecific cva & precerebral occlusion w/o infarct w/o MCC
TRANSIENT ISCHEMIA
Nonspecific cerebrovascular disorders w MCC
Nonspecific cerebrovascular disorders w CC
Nonspecific cerebrovascular disorders w/o CC/MCC
Cranial & peripheral nerve disorders w MCC
Cranial & peripheral nerve disorders w/o MCC
Viral meningitis w CC/MCC
Viral meningitis w/o CC/MCC
Hypertensive encephalopathy w MCC
Hypertensive encephalopathy w CC
Hypertensive encephalopathy w/o CC/MCC
Nontraumatic stupor & coma w MCC
Nontraumatic stupor & coma w/o MCC
Traumatic stupor & coma, coma >1 hr w MCC
Traumatic stupor & coma, coma >1 hr w CC
Traumatic stupor & coma, coma >1 hr w/o CC/MCC
Traumatic stupor & coma, coma <1 hr w MCC
Traumatic stupor & coma, coma <1 hr w CC
Traumatic stupor & coma, coma <1 hr w/o CC/MCC
Concussion w MCC
Concussion w CC
Concussion w/o CC/MCC
Other disorders of nervous system w MCC
Other disorders of nervous system w CC
Other disorders of nervous system w/o CC/MCC
Bacterial & tuberculous infections of nervous system w MCC
Bacterial & tuberculous infections of nervous system w CC
Bacterial & tuberculous infections of nervous system w/o CC/MCC
Non-bacterial infect of nervous sys exc viral meningitis w MCC
Non-bacterial infect of nervous sys exc viral meningitis w CC
Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
10/1/2011
10/1/2011
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
100
101
102
103
104
105
106
107
108
109
110
111
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
Seizures w MCC
Seizures w/o MCC
Headaches w MCC
Headaches w/o MCC
CARDIAC VALVE AND OTH MAJOR CARDIOTHORACIC PROC W
CARDIAC VALVE AND OTH MAJOR CARDIOTHORACIC PROC W/
CORONARY BYPASS W PTCA
CORONARY BYPASS W CARDIAC CATH
OTHER CARDIOTHORACIC PROCEDURES
CORONARY BYPASS W/O PTCA OR CARDIAC CATH
MAJOR CARDIOVASCULAR PROCEDURES W CC
MAJOR CARDIOVASCULAR PROCEDURES W/O CC
Orbital procedures w CC/MCC
Orbital procedures w/o CC/MCC
Extraocular procedures except orbit
Intraocular procedures w CC/MCC
Intraocular procedures w/o CC/MCC
CARDIAC PACEMAKER DEVICE REPLACEMENT
VEIN LIGATION AND STRIPPING
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES
Acute major eye infections w CC/MCC
Acute major eye infections w/o CC/MCC
NEUROLOGICAL EYE DISORDERS
Other disorders of the eye w MCC
Other disorders of the eye w/o MCC
ACUTE AND SUBACUTE ENDOCARDITIS
HEART FAILURE AND SHOCK
DEEP VEIN THROMBOPHLEBITIS
Major head & neck procedures w CC/MCC or major device
Major head & neck procedures w/o CC/MCC
Cranial/facial procedures w CC/MCC
Cranial/facial procedures w/o CC/MCC
Other ear, nose, mouth & throat OR procedures w CC/MCC
Other ear, nose, mouth & throat OR procedures w/o CC/MCC
Sinus & mastoid procedures w CC/MCC
Sinus & mastoid procedures w/o CC/MCC
Mouth procedures w CC/MCC
Mouth procedures w/o CC/MCC
Salivary gland procedures
ANGINA PECTORIS
SYNCOPE AND COLLAPSE W CC
SYNCOPE AND COLLAPSE W/O CC
CHEST PAIN
Other circulatory system diagnoses w CC
OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC
Ear, nose, mouth & throat malignancy w MCC
Ear, nose, mouth & throat malignancy w CC
Ear, nose, mouth & throat malignancy w/o CC/MCC
Dysequilibrium
Epistaxis w MCC
Epistaxis w/o MCC
Otitis media & URI w MCC
Otitis media & URI w/o MCC
Other ear, nose, mouth & throat diagnoses w MCC
Other ear, nose, mouth & throat diagnoses w CC
Other ear, nose, mouth & throat diagnoses w/o CC/MCC
Dental & Oral Diseases w MCC
Dental & Oral Diseases w CC
Dental & Oral Diseases w/o CC/MCC
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL AGE
INGUINAL AND FEMORAL HERNIA PROCEDURES AGE >17 W C
INGUINAL AND FEMORAL HERNIA PROCEDURES AGE >17 W/O
Major chest procedures w MCC
Major chest procedures w CC
Major chest procedures w/o CC/MCC
Other resp system OR procedures w MCC
Other resp system OR procedures w CC
Other resp system OR procedures w/o CC/MCC
MOUTH PROCEDURES W/O CC
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC
DIGESTIVE MALIGNANCY W CC
DIGESTIVE MALIGNANCY W/O CC
G.I. HEMORRHAGE W CC
Pulmonary embolism w MCC
Pulmonary embolism w/o MCC
Respiratory infections & inflammations w MCC
Respiratory infections & inflammations w CC
Respiratory infections & inflammations w/o CC/MCC
Respiratory neoplasms w MCC
Respiratory neoplasms w CC
Respiratory neoplasms w/o CC/MCC
Major chest trauma w MCC
Major chest trauma w CC
Major chest trauma w/o CC/MCC
Pleural effusion w MCC
Pleural effusion w CC
Pleural effusion w/o CC/MCC
Pulmonary edema & respiratory failure
Chronic obstructive pulmonary disease w MCC
Chronic obstructive pulmonary disease w CC
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2004
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
Chronic obstructive pulmonary disease w/o CC/MCC
Simple pneumonia & pleurisy w MCC
Simple pneumonia & pleurisy w CC
Simple pneumonia & pleurisy w/o CC/MCC
Interstitial lung disease w MCC
Interstitial lung disease w CC
Interstitial lung disease w/o CC/MCC
Pneumothorax w MCC
Pneumothorax w CC
Pneumothorax w/o CC/MCC
Bronchitis & asthma w CC/MCC
Bronchitis & asthma w/o CC/MCC
Respiratory signs & symptoms
Other respiratory system diagnoses w MCC
Other respiratory system diagnoses w/o MCC
Respiratory system diagnosis w ventilator support 96+ hours
Respiratory system diagnosis w ventilator support <96 hours
MAJOR JOINT AND LIMB REATTACHMENT PROCEDURES OF LO
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >1
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >1
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONN TIS
OTHER HEART ASSIST SYSTEM IMPLANT
Cardiac valve & oth maj cardiothoracic proc w card cath w MCC
Cardiac valve & oth maj cardiothoracic proc w card cath w CC
Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC
Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC
Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC
Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC
Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC
Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC
Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC
Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC
Cardiac defibrillator implant w/o cardiac cath w MCC
Cardiac defibrillator implant w/o cardiac cath w/o MCC
Other cardiothoracic procedures w MCC
Other cardiothoracic procedures w CC
Other cardiothoracic procedures w/o CC/MCC
Coronary bypass w PTCA w MCC
Coronary bypass w PTCA w/o MCC
Coronary bypass w cardiac cath w MCC
Coronary bypass w cardiac cath w/o MCC
Coronary bypass w/o cardiac cath w MCC
Coronary bypass w/o cardiac cath w/o MCC
Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair
Major cardiovasc procedures w/o MCC
Amputation for circ sys disorders exc upper limb & toe w MCC
Amputation for circ sys disorders exc upper limb & toe w CC
Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC
Permanent cardiac pacemaker implant w MCC
Permanent cardiac pacemaker implant w CC
Permanent cardiac pacemaker implant w/o CC/MCC
AICD generator procedures
Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents
Perc cardiovasc proc w drug-eluting stent w/o MCC
Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents
Perc cardiovasc proc w non-drug-eluting stent w/o MCC
Perc cardiovasc proc w/o coronary artery stent w MCC
Perc cardiovasc proc w/o coronary artery stent w/o MCC
Other vascular procedures w MCC
Other vascular procedures w CC
Other vascular procedures w/o CC/MCC
Upper limb & toe amputation for circ system disorders w MCC
Upper limb & toe amputation for circ system disorders w CC
Upper limb & toe amputation for circ system disorders w/o CC/MCC
Cardiac pacemaker device replacement w MCC
Cardiac pacemaker device replacement w/o MCC
Cardiac pacemaker revision except device replacement w MCC
Cardiac pacemaker revision except device replacement w CC
Cardiac pacemaker revision except device replacement w/o CC/MCC
Vein ligation & stripping
Other circulatory system OR procedures
AICD lead procedures
SKIN GRAFT AND/OR DEBRID EXCEPT FOR SKIN ULCER OR
PERIANAL AND PILONIDAL PROCEDURES
SKIN, SUBCUTANEOUS TISSUE AND BREAST PLASTIC PROCE
OTHER SKIN, SUBCUT TISS AND BREAST PROC W CC
OTHER SKIN, SUBCUT TISS AND BREAST PROC W/O CC
SKIN ULCERS
MAJOR SKIN DISORDERS W CC
MAJOR SKIN DISORDERS W/O CC
MALIGNANT BREAST DISORDERS W CC
MALIGNANT BREAST DISORDERS W/O CC
NON-MALIGANT BREAST DISORDERS
CELLULITIS AGE >17 W CC
CELLULITIS AGE >17 W/O CC
CELLULITIS AGE 0-17
Acute myocardial infarction, discharged alive w MCC
Acute myocardial infarction, discharged alive w CC
Acute myocardia infarction, discharged alive w/o CC/MCC
Acute myocardial infarction, expired w MCC
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
Acute myocardial infarction, expired w CC
Acute myocardial infarction, expired w/o CC/MCC
Circulatory disorders except AMI, w card cath w MCC
Circulatory disorders except AMI, w card cath w/o MCC
Acute & subacute endocarditis w MCC
Acute & subacute endocarditis w CC
Acute & subacute endocarditis w/o CC/MCC
Heart failure & shock w MCC
Heart failure & shock w CC
Heart failure & shock w/o CC/MCC
Deep vein thrombophlebitis w CC/MCC
Deep vein thrombophlebitis w/o CC/MCC
Cardiac arrest, unexplained w MCC
Cardiac arrest, unexplained w CC
Cardiac arrest, unexplained w/o CC/MCC
Peripheral vascular disorders w MCC
Peripheral vascular disorders w CC
Peripheral vascular disorders w/o CC/MCC
Atherosclerosis w MCC
Atherosclerosis w/o MCC
Hypertension w MCC
Hypertension w/o MCC
Cardiac congenital & valvular disorders w MCC
Cardiac congenital & valvular disorders w/o MCC
Cardiac arrhythmia & conduction disorders w MCC
Cardiac arrhythmia & conduction disorders w CC
Cardiac arrhythmia & conduction disorders w/o CC/MCC
Angina pectoris
Syncope & collapse
Chest pain
Other circulatory system diagnoses w MCC
OTHER CIRCULATORY SYSTEM DIAGNOSES W CC
Other circulatory system diagnoses w/o CC/MCC
ADMIT FOR RENAL DIALYSIS
KIDNEY AND URINARY TRACT NEOPLASMS W CC
KIDNEY AND URINARY TRACT NEOPLASMS W/O CC
KIDNEY AND URINARY TRACT INFECTIONS AGE >17 W CC
KIDNEY AND URINARY TRACT INFECTIONS AGE >17 W/O CC
KIDNEY AND URINARY TRACT INFECTIONS AGE 0-17
URINARY STONES W CC, AND/OR ESW LITHOTRIPSY
URINARY STONES W/O CC
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS AGE >1
Stomach, esophageal & duodenal proc w MCC
Stomach, esophageal & duodenal proc w CC
Stomach, esophageal & duodenal proc w/o CC/MCC
Major small & large bowel procedures w MCC
Major small & large bowel procedures w CC
Major small & large bowel procedures w/o CC/MCC
Rectal resection w MCC
Rectal resection w CC
Rectal resection w/o CC/MCC
Peritoneal adhesiolysis w MCC
Peritoneal adhesiolysis w CC
Peritoneal adhesiolysis w/o CC/MCC
Appendectomy w complicated principal diag w MCC
Appendectomy w complicated principal diag w CC
Appendectomy w complicated principal diag w/o CC/MCC
Appendectomy w/o complicated principal diag w MCC
Appendectomy w/o complicated principal diag w CC
Appendectomy w/o complicated principal diag w/o CC/MCC
Minor small & large bowel procedures w MCC
Minor small & large bowel procedures w CC
Minor small & large bowel procedures w/o CC/MCC
Anal & stomal procedures w MCC
Anal & stomal procedures w CC
Anal & stomal procedures w/o CC/MCC
Inguinal & femoral hernia procedures w MCC
Inguinal & femoral hernia procedures w CC
Inguinal & femoral hernia procedures w/o CC/MCC
Hernia procedures except inguinal & femoral w MCC
Hernia procedures except inguinal & femoral w CC
Hernia procedures except inguinal & femoral w/o CC/MCC
Other digestive system OR procedures w MCC
Other digestive system OR procedures w CC
Other digestive system OR procedures w/o CC/MCC
UTERINE AND ADNEXA PROC FOR NON-MALIGNANCY W/O CC
VAGINA, CERVIX AND VULVA PROCEDURES
LAPAROSCOPY AND INCISIONAL TUBAL INTERRUPTION
ENDOSCOPIC TUBAL INTERRUPTION
D AND C, CONIZATION AND RADIO-IMPLANT, FOR MALIGNA
D AND C, CONIZATION EXCEPT FOR MALIGNANCY
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES
Malignancy, female reproductive system w CC
MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC
Major esophageal disorders w MCC
Major esophageal disorders w CC
Major esophageal disorders w/o CC/MCC
Major gastrointestinal disorders & peritoneal infections w MCC
Major gastrointestinal disorders & peritoneal infections w CC
Major gastrointestinal disorders & peritoneal infections w/o CC/MCC
Digestive malignancy w MCC
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
Digestive malignancy w CC
Digestive malignancy w/o CC/MCC
G.I. hemorrhage w MCC
G.I. hemorrhage w CC
G.I. hemorrhage w/o CC/MCC
Complicated peptic ulcer w MCC
Complicated peptic ulcer w CC
Complicated peptic ulcer w/o CC/MCC
Uncomplicated peptic ulcer w MCC
Uncomplicated peptic ulcer w/o MCC
Inflammatory bowel disease w MCC
Inflammatory bowel disease w CC
Inflammatory bowel disease w/o CC/MCC
G.I. obstruction w MCC
G.I. obstruction w CC
G.I. obstruction w/o CC/MCC
Esophagitis, gastroent & misc digest disorders w MCC
Esophagitis, gastroent & misc digest disorders w/o MCC
Other digestive system diagnoses w MCC
Other digestive system diagnoses w CC
Other digestive system diagnoses w/o CC/MCC
RED BLOOD CELL DISORDERS AGE 0-17
COAGULATION DISORDERS
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS W CC
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS W/O CC
LYMPHOMA AND NON-ACUTE LEUKEMIA W OTHER O.R. PROC
LYMPHOMA AND NON-ACUTE LEUKEMIA W OTHER O.R. PROC
LYMPHOMA AND NON-ACUTE LEUKEMIA W CC
LYMPHOMA AND NON-ACUTE LEUKEMIA W/O CC
Pancreas, liver & shunt procedures w MCC
Pancreas, liver & shunt procedures w CC
Pancreas, liver & shunt procedures w/o CC/MCC
Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC
Biliary tract proc except only cholecyst w or w/o c.d.e. w CC
Biliary tract proc except only cholecyst w or w/o c.d.e. w/o CC/MCC
Cholecystectomy w c.d.e. w MCC
Cholecystectomy w c.d.e. w CC
Cholecystectomy w c.d.e. w/o CC/MCC
Cholecystectomy except by laparoscope w/o c.d.e. w MCC
Cholecystectomy except by laparoscope w/o c.d.e. w CC
Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC
Laparoscopic cholecystectomy w/o c.d.e. w MCC
Laparoscopic cholecystectomy w/o c.d.e. w CC
Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC
Hepatobiliary diagnostic procedures w MCC
Hepatobiliary diagnostic procedures w CC
Hepatobiliary diagnostic procedures w/o CC/MCC
Other hepatobiliary or pancreas OR procedures w MCC
Other hepatobiliary or pancreas OR procedures w CC
Other hepatobiliary or pancreas OR procedures w/o CC/MCC
Depressive neuroses
Neuroses except depressive
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
ORGANIC DISTURBANCES AND MENTAL RETARDATION
Psychoses
CHILDHOOD MENTAL DISORDERS
Cirrhosis & alcoholic hepatitis w MCC
Cirrhosis & alcoholic hepatitis w CC
Cirrhosis & alcoholic hepatitis w/o CC/MCC
Malignancy of hepatobiliary system or pancreas w MCC
Malignancy of hepatobiliary system or pancreas w CC
Malignancy of hepatobiliary system or pancreas w/o CC/MCC
Disorders of pancreas except malignancy w MCC
Disorders of pancreas except malignancy w CC
Disorders of pancreas except malignancy w/o CC/MCC
Disorders of liver except malig,cirr,alc hepa w MCC
Disorders of liver except malig,cirr,alc hepa w CC
Disorders of liver except malig,cirr,alc hepa w/o CC/MCC
Disorders of the biliary tract w MCC
Disorders of the biliary tract w CC
Disorders of the biliary tract w/o CC/MCC
ALLERGIC REACTIONS AGE >17
ALLERGIC REACTIONS AGE 0-17
POISONING AND TOXIC EFFECTS OF DRUGS AGE >17 W CC
POISONING AND TOXIC EFFECTS OF DRUGS AGE >17 W/O C
POISONING AND TOXIC EFFECTS OF DRUGS AGE 0-17
COMPLICATIONS OF TREATMENT W CC
Combined anterior/posterior spinal fusion w MCC
Combined anterior/posterior spinal fusion w CC
Combined anterior/posterior spinal fusion w/o CC/MCC
Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC
Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC
Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC
Spinal fusion except cervical w MCC
Spinal fusion except cervical w/o MCC
Bilateral or multiple major joint procs of lower extremity w MCC
Bilateral or multiple major joint procs of lower extremity w/o MCC
Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w MCC
Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC
Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC
Revision of hip or knee replacement w MCC
1/1/2011
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1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500
501
502
503
504
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508
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510
511
512
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516
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521
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523
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525
526
527
528
529
530
531
532
533
534
535
536
537
538
539
540
541
542
543
544
545
546
547
548
549
550
551
552
553
554
555
556
557
Revision of hip or knee replacement w CC
Revision of hip or knee replacement w/o CC/MCC
Major joint replacement or reattachment of lower extremity w MCC
Major joint replacement or reattachment of lower extremity w/o MCC
Cervical spinal fusion w MCC
Cervical spinal fusion w CC
Cervical spinal fusion w/o CC/MCC
Amputation for musculoskeletal sys & conn tissue dis w MCC
Amputation for musculoskeletal sys & conn tissue dis w CC
Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC
Biopsies of musculoskeletal system & connective tissue w MCC
Biopsies of musculoskeletal system & connective tissue w CC
Biopsies of musculoskeletal system & connective tissue w/o CC/MCC
Hip & femur procedures except major joint w MCC
Hip & femur procedures except major joint w CC
Hip & femur procedures except major joint w/o CC/MCC
Major joint & limb reattachment proc of upper extremity w CC/MCC
Major joint & limb reattachment proc of upper extremity w/o CC/MCC
Knee procedures w pdx of infection w MCC
Knee procedures w pdx of infection w CC
Knee procedures w pdx of infection w/o CC/MCC
Knee procedures w/o pdx of infection w CC/MCC
Knee procedures w/o pdx of infection w/o CC/MCC
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim
Back & neck proc exc spinal fusion w/o CC/MCC
Lower extrem & humer proc except hip,foot,femur w MCC
Lower extrem & humer proc except hip,foot,femur w CC
Lower extrem & humer proc except hip,foot,femur w/o CC/MCC
Local excision & removal int fix devices exc hip & femur w MCC
Local excision & removal int fix devices exc hip & femur w CC
Local excision & removal int fix devices exc hip & femur w/o CC/MCC
Local excision & removal int fix devices of hip & femur w CC/MCC
Local excision & removal int fix devices of hip & femur w/o CC/MCC
Soft tissue procedures w MCC
Soft tissue procedures w CC
Soft tissue procedures w/o CC/MCC
Foot procedures w MCC
Foot procedures w CC
Foot procedures w/o CC/MCC
Major thumb or joint procedures
Major shoulder or elbow joint procedures w CC/MCC
Major shoulder or elbow joint procedures w/o CC/MCC
Arthroscopy
Shoulder,elbow or forearm proc,exc major joint proc w MCC
Shoulder,elbow or forearm proc,exc major joint proc w CC
Shoulder,elbow or forearm proc,exc major joint proc w/o CC/MCC
Hand or wrist proc, except major thumb or joint proc w CC/MCC
Hand or wrist proc, except major thumb or joint proc w/o CC/MCC
Other musculoskelet sys & conn tiss OR proc w MCC
Other musculoskelet sys & conn tiss OR proc w CC
Other musculoskelet sys & conn tiss OR proc w/o CC/MCC
PERC CARDIO PROC W/O CORONARY ARTERY STENT OR AMI
CERVICAL SPINAL FUSION W CC
CERVICAL SPINAL FUSION W/O CC
ALCOHOL/DRUG ABUSE OR DEPENDENCE W CC
ALC/DRUG ABUSE OR DEPEND W REHABILITATION THERAPY
ALC/DRUG ABUSE OR DEPEND W/O REHABILITATION THERAP
Transient ischemia
Other heart assist system implant
PERCUTANEOUS CARDIOVASCULAR PROC WITH STENT
PERCUTNEOUS CARDIOVASULAR PROC W DRUG ELUTING STEN
INTRACRANIAL VASCULAR PROC W PDX HEMORRHAGE
VENTRICULAR SHUNT PROCEDURES W CC
VENTRICULAR SHUNT PROCEDURES W/O CC
SPINAL PROCEDURES W CC
SPINAL PROCEDURES W/O CC
Fractures of femur w MCC
Fractures of femur w/o MCC
Fractures of hip & pelvis w MCC
Fractures of hip & pelvis w/o MCC
Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC
Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC
Osteomyelitis w MCC
Osteomyelitis w CC
Osteomyelitis w/o CC/MCC
Pathological fractures & musculoskelet & conn tiss malig w MCC
Pathological fractures & musculoskelet & conn tiss malig w CC
Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC
Connective tissue disorders w MCC
Connective tissue disorders w CC
Connective tissue disorders w/o CC/MCC
Septic arthritis w MCC
Septic arthritis w CC
Septic arthritis w/o CC/MCC
Medical back problems w MCC
Medical back problems w/o MCC
Bone diseases & arthropathies w MCC
Bone diseases & arthropathies w/o MCC
Signs & symptoms of musculoskeletal system & conn tissue w MCC
Signs & symptoms of musculoskeletal system & conn tissue w/o MCC
Tendonitis, myositis & bursitis w MCC
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
558
559
560
561
562
563
564
565
566
567
568
569
570
571
572
573
574
575
576
577
578
579
580
581
582
583
584
585
588
589
591
592
593
594
595
596
597
598
599
600
601
602
603
604
605
606
607
608
609
611
612
613
614
615
616
617
618
619
620
621
622
623
624
625
626
627
628
629
630
631
633
634
636
637
638
639
640
641
642
643
644
645
650
651
652
653
654
655
656
657
658
Tendonitis, myositis & bursitis w/o MCC
Aftercare, musculoskeletal system & connective tissue w MCC
Aftercare, musculoskeletal system & connective tissue w CC
Aftercare, musculoskeletal system & connective tissue w/o CC/MCC
Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC
Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC
Other musculoskeletal sys & connective tissue diagnoses w MCC
Other musculoskeletal sys & connective tissue diagnoses w CC
Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC
STOMACH, ESOPHAGEAL & DUODENAL PROC AGE LESS THAN
STOMACH, ESOPHAGEAL & DUODENAL PROC AGE LESS THAN
MAJOR SMALL & LARGE BOWEL PROC W CC W/O MAJOR GI
Skin Debridement W MCC
Skin Debridement W CC
Skin Debridement W/O CC/MCC
Skin graft &/or debrid for skn ulcer or cellulitis w MCC
Skin graft &/or debrid for skn ulcer or cellulitis w CC
Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/MCC
Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC
Skin graft &/or debrid exc for skin ulcer or cellulitis w CC
Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC
Other skin, subcut tiss & breast proc w MCC
Other skin, subcut tiss & breast proc w CC
Other skin, subcut tiss & breast proc w/o CC/MCC
Mastectomy for malignancy w CC/MCC
Mastectomy for malignancy w/o CC/MCC
Breast biopsy, local excision & other breast procedures w CC/MCC
Breast biopsy, local excision & other breast procedures w/o CC/MCC
NEONATE BWT <1500G W MAJOR PROCEDURE
NEONATE BWT <500G OR GA <24 WEEKS
NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE
Skin ulcers w MCC
Skin ulcers w CC
Skin ulcers w/o CC/MCC
Major skin disorders w MCC
Major skin disorders w/o MCC
Malignant breast disorders w MCC
Malignant breast disorders w CC
Malignant breast disorders w/o CC/MCC
Non-malignant breast disorders w CC/MCC
Non-malignant breast disorders w/o CC/MCC
Cellulitis w MCC
Cellulitis w/o MCC
Trauma to the skin, subcut tiss & breast w MCC
Trauma to the skin, subcut tiss & breast w/o MCC
Minor skin disorders w MCC
Minor skin disorders w/o MCC
NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION
NEONATE BWT 1500-2499G W MAJOR PROCEDURE
NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY
NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND
NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION
Adrenal & pituitary procedures w CC/MCC
Adrenal & pituitary procedures w/o CC/MCC
Amputat of lower limb for endocrine,nutrit,& metabol dis w MCC
Amputat of lower limb for endocrine,nutrit,& metabol dis w CC
Amputat of lower limb for endocrine,nutrit,& metabol dis w/o CC/MCC
OR procedures for obesity w MCC
OR procedures for obesity w CC
OR procedures for obesity w/o CC/MCC
Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC
Skin grafts & wound debrid for endoc, nutrit & metab dis w CC
Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC
Thyroid, parathyroid & thyroglossal procedures w MCC
Thyroid, parathyroid & thyroglossal procedures w CC
Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC
Other endocrine, nutrit & metab OR proc w MCC
Other endocrine, nutrit & metab OR proc w CC
Other endocrine, nutrit & metab OR proc w/o CC/MCC
NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE
NEONATE BIRTHWT >2499G W MAJOR ANOMALY
NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND
NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION
Diabetes w MCC
Diabetes w CC
Diabetes w/o CC/MCC
Nutritional & misc metabolic disorders w MCC
Nutritional & misc metabolic disorders w/o MCC
Inborn errors of metabolism
Endocrine disorders w MCC
Endocrine disorders w CC
Endocrine disorders w/o CC/MCC
SPLENECTOMY
OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS
Kidney transplant
Major bladder procedures w MCC
Major bladder procedures w CC
Major bladder procedures w/o CC/MCC
Kidney & ureter procedures for neoplasm w MCC
Kidney & ureter procedures for neoplasm w CC
Kidney & ureter procedures for neoplasm w/o CC/MCC
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
10/1/2006
10/1/2006
10/1/2006
10/1/2011
10/1/2011
10/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
6/1/2012
9/1/2012
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
9/1/2012
9/1/2012
9/1/2012
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
9/1/2012
9/1/2012
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
659
660
661
662
663
664
665
666
667
668
669
670
671
672
673
674
675
680
681
682
683
684
685
686
687
688
689
690
691
692
693
694
695
696
697
698
699
700
707
708
709
710
711
712
713
714
715
716
717
718
720
721
722
723
724
725
726
727
728
729
730
734
735
736
737
738
739
740
741
742
743
744
745
746
747
748
749
750
751
752
753
754
755
756
757
758
759
760
761
765
766
Kidney & ureter procedures for non-neoplasm w MCC
Kidney & ureter procedures for non-neoplasm w CC
Kidney & ureter procedures for non-neoplasm w/o CC/MCC
Minor bladder procedures w MCC
Minor bladder procedures w CC
Minor bladder procedures w/o CC/MCC
Prostatectomy w MCC
Prostatectomy w CC
Prostatectomy w/o CC/MCC
Transurethral procedures w MCC
Transurethral procedures w CC
Transurethral procedures w/o CC/MCC
Urethral procedures w CC/MCC
Urethral procedures w/o CC/MCC
Other kidney & urinary tract procedures w MCC
Other kidney & urinary tract procedures w CC
Other kidney & urinary tract procedures w/o CC/MCC
MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS
OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS
Renal failure w MCC
Renal failure w CC
Renal failure w/o CC/MCC
Admit for renal dialysis
Kidney & urinary tract neoplasms w MCC
Kidney & urinary tract neoplasms w CC
Kidney & urinary tract neoplasms w/o CC/MCC
Kidney & urinary tract infections w MCC
Kidney & urinary tract infections w/o MCC
Urinary stones w esw lithotripsy w CC/MCC
Urinary stones w esw lithotripsy w/o CC/MCC
Urinary stones w/o esw lithotripsy w MCC
Urinary stones w/o esw lithotripsy w/o MCC
Kidney & urinary tract signs & symptoms w MCC
Kidney & urinary tract signs & symptoms w/o MCC
Urethral stricture
Other kidney & urinary tract diagnoses w MCC
Other kidney & urinary tract diagnoses w CC
Other kidney & urinary tract diagnoses w/o CC/MCC
Major male pelvic procedures w CC/MCC
Major male pelvic procedures w/o CC/MCC
Penis procedures w CC/MCC
Penis procedures w/o CC/MCC
Testes procedures w CC/MCC
Testes procedures w/o CC/MCC
Transurethral prostatectomy w CC/MCC
Transurethral prostatectomy w/o CC/MCC
Other male reproductive system OR proc for malignancy w CC/MCC
Other male reproductive system OR proc for malignancy w/o CC/MCC
Other male reproductive system OR proc exc malignancy w CC/MCC
Other male reproductive system OR proc exc malignancy w/o CC/MCC
SEPTICEMIA & DISSEMINATED INFECTIONS
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
Malignancy, male reproductive system w MCC
Malignancy, male reproductive system w CC
Malignancy, male reproductive system w/o CC/MCC
Benign prostatic hypertrophy w MCC
Benign prostatic hypertrophy w/o MCC
Inflammation of the male reproductive system w MCC
Inflammation of the male reproductive system w/o MCC
Other male reproductive system diagnoses w CC/MCC
Other male reproductive system diagnoses w/o CC/MCC
Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC
Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC
Uterine & adnexa proc for ovarian or adnexal malignancy w MCC
Uterine & adnexa proc for ovarian or adnexal malignancy w CC
Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC
Uterine,adnexa proc for non-ovarian/adnexal malig w MCC
Uterine,adnexa proc for non-ovarian/adnexal malig w CC
Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC
Uterine & adnexa proc for non-malignancy w CC/MCC
Uterine & adnexa proc for non-malignancy w/o CC/MCC
D&C, conization, laparascopy & tubal interruption w CC/MCC
D&C, conization, laparascopy & tubal interruption w/o CC/MCC
Vagina, cervix & vulva procedures w CC/MCC
Vagina, cervix & vulva procedures w/o CC/MCC
Female reproductive system reconstructive procedures
Other female reproductive system OR procedures w CC/MCC
Other female reproductive system OR procedures w/o CC/MCC
MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES
Disorders of personality & impulse control
BIPOLAR DISORDERS
Malignancy, female reproductive system w MCC
MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC
Malignancy, female reproductive system w/o CC/MCC
Infections, female reproductive system w MCC
Infections, female reproductive system w CC
Infections, female reproductive system w/o CC/MCC
Menstrual & other female reproductive system disorders w CC/MCC
Menstrual & other female reproductive system disorders w/o CC/MCC
Cesarean section w CC/MCC
Cesarean section w/o CC/MCC
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
1/1/2011
9/1/2012
1/1/2011
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
767
768
769
770
772
773
774
775
776
777
778
779
780
781
782
789
790
791
792
793
794
795
799
800
801
802
803
804
808
809
810
811
812
813
814
815
816
820
821
822
823
824
825
826
827
828
829
830
834
835
836
837
838
839
840
841
842
843
844
845
846
847
848
849
850
853
854
855
856
857
858
860
861
862
863
864
865
866
867
868
869
870
871
872
876
880
881
882
883
884
885
Vaginal delivery w sterilization &/or D&C
Vaginal delivery w OR proc except steril &/or D&C
Postpartum & post abortion diagnoses w OR procedure
Abortion w D&C, aspiration curettage or hysterotomy
ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY
OPIOID ABUSE & DEPENDENCE
Vaginal delivery w complicating diagnoses
Vaginal delivery w/o complicating diagnoses
Postpartum & post abortion diagnoses w/o OR procedure
Ectopic pregnancy
Threatened abortion
Abortion w/o D&C
False labor
Other antepartum diagnoses w medical complications
Other antepartum diagnoses w/o medical complications
Neonates, died or transferred to another acute care facility
Extreme immaturity or respiratory distress syndrome, neonate
Prematurity w major problems
Prematurity w/o major problems
Full term neonate w major problems
Neonate w other significant problems
Normal newborn
Splenectomy w MCC
Splenectomy w CC
Splenectomy w/o CC/MCC
Other OR proc of the blood & blood forming organs w MCC
Other OR proc of the blood & blood forming organs w CC
Other OR proc of the blood & blood forming organs w/o CC/MCC
Major hematol/immun diag exc sickle cell crisis & coagul w MCC
Major hematol/immun diag exc sickle cell crisis & coagul w CC
Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC
Red blood cell disorders w MCC
Red blood cell disorders w/o MCC
Coagulation disorders
Reticuloendothelial & immunity disorders w MCC
Reticuloendothelial & immunity disorders w CC
Reticuloendothelial & immunity disorders w/o CC/MCC
Lymphoma & leukemia w major OR procedure w MCC
Lymphoma & leukemia w major OR procedure w CC
Lymphoma & leukemia w major OR procedure w/o CC/MCC
Lymphoma & non-acute leukemia w other OR proc w MCC
Lymphoma & non-acute leukemia w other OR proc w CC
Lymphoma & non-acute leukemia w other OR proc w/o CC/MCC
Myeloprolif disord or poorly diff neopl w maj OR proc w MCC
Myeloprolif disord or poorly diff neopl w maj OR proc w CC
Myeloprolif disord or poorly diff neopl w maj OR proc w/o CC/MCC
Myeloprolif disord or poorly diff neopl w other OR proc w CC/MCC
Myeloprolif disord or poorly diff neopl w other OR proc w/o CC/MCC
Acute leukemia w/o major OR procedure w MCC
Acute leukemia w/o major OR procedure w CC
Acute leukemia w/o major OR procedure w/o CC/MCC
Chemo w acute leukemia as sdx or w high dose chemo agent w MCC
Chemo w acute leukemia as sdx w CC or high dose chemo agent
Chemo w acute leukemia as sdx w/o CC/MCC
Lymphoma & non-acute leukemia w MCC
Lymphoma & non-acute leukemia w CC
Lymphoma & non-acute leukemia w/o CC/MCC
Other myeloprolif dis or poorly diff neopl diag w MCC
Other myeloprolif dis or poorly diff neopl diag w CC
Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC
Chemotherapy w/o acute leukemia as secondary diagnosis w MCC
Chemotherapy w/o acute leukemia as secondary diagnosis w CC
Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC
Radiotherapy
EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT
Infectious & parasitic diseases w OR procedure w MCC
Infectious & parasitic diseases w OR procedure w CC
Infectious & parasitic diseases w OR procedure w/o CC/MCC
Postoperative or post-traumatic infections w OR proc w MCC
Postoperative or post-traumatic infections w OR proc w CC
Postoperative or post-traumatic infections w OR proc w/o CC/MCC
REHABILITATION
SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS
Postoperative & post-traumatic infections w MCC
Postoperative & post-traumatic infections w/o MCC
Fever
Viral illness w MCC
Viral illness w/o MCC
Other infectious & parasitic diseases diagnoses w MCC
Other infectious & parasitic diseases diagnoses w CC
Other infectious & parasitic diseases diagnoses w/o CC/MCC
Septicemia or severe sepsis w MV 96+ hours
Septicemia or severe sepsis w/o MV 96+ hours w MCC
Septicemia or severe sepsis w/o MV 96+ hours w/o MCC
OR procedure w principal diagnoses of mental illness
Acute adjustment reaction & psychosocial dysfunction
DEPRESSIVE NEUROSES
NEUROSES EXCEPT DEPRESSIVE
DISORDERS OF PERSONALITY & IMPULSE CONTROL
Organic disturbances & mental retardation
PSYCHOSES
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2004
1/1/2004
9/1/2012
1/1/2011
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
DRG
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
886
887
890
892
893
894
895
896
897
901
902
903
904
905
906
907
908
909
910
911
912
913
914
915
916
917
918
919
920
921
922
923
927
928
929
930
933
934
935
939
940
941
945
946
947
948
949
950
951
952
955
956
957
958
959
963
964
965
969
970
974
975
976
977
981
982
983
984
985
986
987
988
989
998
999
3210F
3250F
3775F
3776F
6010F
6015F
A0021
A0080
A0090
A0100
A0110
A0120
A0130
A0140
A0160
A0170
Behavioral & developmental disorders
Other mental disorder diagnoses
HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS
HIV W MAJOR HIV RELATED CONDITION
HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
Alcohol/drug abuse or dependence, left ama
Alcohol/drug abuse or dependence w rehabilitation therapy
Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC
Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC
Wound debridements for injuries w MCC
Wound debridements for injuries w CC
Wound debridements for injuries w/o CC/MCC
Skin grafts for injuries w CC/MCC
Skin grafts for injuries w/o CC/MCC
Hand procedures for injuries
Other OR procedures for injuries w MCC
Other OR procedures for injuries w CC
Other OR procedures for injuries w/o CC/MCC
Craniotomy for multiple significant trauma
EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA
MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
Traumatic injury w MCC
Traumatic injury w/o MCC
Allergic reactions w MCC
Allergic reactions w/o MCC
Poisoning & toxic effects of drugs w MCC
Poisoning & toxic effects of drugs w/o MCC
Complications of treatment w MCC
Complications of treatment w CC
Complications of treatment w/o CC/MCC
Other injury, poisoning & toxic effect diag w MCC
Other injury, poisoning & toxic effect diag w/o MCC
Extensive burns or full thickness burns w MV 96+ hrs w skin graft
Full thickness burn w skin graft or inhal inj w CC/MCC
Full thickness burn w skin graft or inhal inj w/o CC/MCC
MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE
Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft
Full thickness burn w/o skin grft or inhal inj
Non-extensive burns
OR proc w diagnoses of other contact w health services w MCC
OR proc w diagnoses of other contact w health services w CC
OR proc w diagnoses of other contact w health services w/o CC/MCC
Rehabilitation w CC/MCC
Rehabilitation w/o CC/MCC
Signs & symptoms w MCC
Signs & symptoms w/o MCC
Aftercare w CC/MCC
Aftercare w/o CC/MCC
Other factors influencing health status
NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
Limb reattachment, hip & femur proc for multiple significant trauma
Other OR procedures for multiple significant trauma w MCC
Other OR procedures for multiple significant trauma w CC
Other OR procedures for multiple significant trauma w/o CC/MCC
Other multiple significant trauma w MCC
Other multiple significant trauma w CC
Other multiple significant trauma w/o CC/MCC
HIV w extensive OR procedure w MCC
HIV w extensive OR procedure w/o MCC
HIV w major related condition w MCC
HIV w major related condition w CC
HIV w major related condition w/o CC/MCC
HIV w or w/o other related condition
Extensive OR procedure unrelated to principal diagnosis w MCC
Extensive OR procedure unrelated to principal diagnosis w CC
Extensive OR procedure unrelated to principal diagnosis w/o CC/MCC
Prostatic OR procedure unrelated to principal diagnosis w MCC
Prostatic OR procedure unrelated to principal diagnosis w CC
Prostatic OR procedure unrelated to principal diagnosis w/o CC/MCC
Non-extensive OR proc unrelated to principal diagnosis w MCC
Non-extensive OR proc unrelated to principal diagnosis w CC
Non-extensive OR proc unrelated to principal diagnosis w/o CC/MCC
Principal diagnosis invalid as discharge diagnosis
Ungroupable
GROUP A STREP TEST PERFORMED (PHAR)
SPECIMEN SITE OTHER THAN ANATOMIC LOCATION OF PRIM
ADENOMA(S)/NEOPLASM DETECTED SCRNG CLNSCPY
ADENOMA(S)/NEOPLASM NOT DETECTED SCRNG CLNSCPY
DYSPHAGIA SCREENING CONDUCTED PRIOR TO ORDER FOR OR RECEIPT OF ANY FOODS, FLUID
PATIENT RECEIVING OR ELIGIBLE TO RECEIVE FOODS, FLUIDS, OR MEDICATION BY MOUTH (ST
OUTSIDE STATE AMBULANCE SERVICE
NONINTEREST ESCORT IN NON ER
INTEREST ESCORT IN NON ER
NONEMERGENCY TRANSPORT TAXI
NONEMERGENCY TRANSPORT BUS
NON ER TRANSPORT MINI-BUS
NON ER TRANSPORT WHEELCHAIR VAN
NON EMERGENCY TRANSPORT AIR
NON ER TRANSPORT CASE WORKER
TRANSPORT PARKING FEES/TOLLS
1/1/2011
1/1/2011
9/1/2012
9/1/2012
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
9/1/2012
9/1/2012
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2011
10/1/2009
4/1/2014
4/1/2014
1/1/2011
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
all inpatient confinements require auth
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
A0180
A0190
A0200
A0210
A0225
A0380
A0382
A0384
A0390
A0392
A0394
A0396
A0398
A0420
A0422
A0424
A0425
A0426
A0427
A0428
A0429
A0430
A0431
A0432
A0433
A0434
A0435
A0436
A0888
A0998
A0999
A4206
A4207
A4208
A4209
A4210
A4211
A4212
A4213
A4215
A4216
A4217
A4218
A4220
A4221
A4222
A4223
A4230
A4231
A4232
A4233
A4234
A4235
A4236
A4244
A4245
A4246
A4247
A4248
A4250
A4252
A4253
A4255
A4256
A4258
A4259
A4261
A4263
A4264
A4265
A4266
A4267
A4268
A4269
A4270
A4280
A4281
A4282
A4283
A4284
A4285
A4286
A4290
A4300
A4301
A4305
A4306
A4310
A4311
A4312
A4313
NON ER TRANSPORT LODGING RECIPIENT
NON ER TRANSPORT MEALS RECIPIENT
NON ER TRANSPORT LODGING ESCORT
NON ER TRANSPORT MEALS ESCORT
NEONATAL EMERGENCY TRANSPORT ONE WAY
BASIC LIFE SUPPORT MILEAGE
BASIC LIFE SUPPORT ROUTINE SUPPLIES
BASIC LIFE SUPPORT DEFIBRILLATION SUPPLIES
ADVANCED LIFE SUPPORT MILEAGE
ADVANCED LIFE SUPPORT DEFIBRILLATION SUPPLIES
ADVANCED LIFE SUPPORT IV DRUG THERAPY SUPPLIES
ADVANCED LIFE SUPPORT ESOPHAGEAL INTUBATION SUPPLI
ADVANCED LIFE SUPPORT ROUTINE DISPOSABLE SUPPLIES
AMBULANCE WAITING TIME IN 1/2 HOUR INCREMENTS
AMBULANCE OXYGEN LIFE SUSTAINING
EXTRA AMBULANCE ATTENDANT
GROUND MILEAGE
ALS 1
ALS1 EMERGENCY
BLS
BLS-EMERGENCY
FIXED WING AIR TRANSPORT
ROTARY WING AIR TRANSPORT
PI VOLUNTEER AMBULANCE COMP
ALS 2
SPECIALTY CARE TRANSPORT
FIXED WING AIR MILEAGLE
ROTARY WING AIR MILEAGE
NON COVERED AMBULANCE MILEAGE
AMBULANCE RESPONSE AND TREATMENT,NO TRANSPORT
UNLISTED AMBULANCE SERVICE
SYRINGE WITH NEEDLE, STERILE 1CC, EACH
SYRINGE WITH NEEDLE, STERILE 2CC, EACH
SYRINGE WITH NEEDLE, STERILE 3CC, EACH
SYRINGE WITH NEEDLE, STERILE 5CC OR GREATER, EACH
NEEDLE-FREE INJECTION DEVICE, EACH
SUPPLIES FOR SELF ADMINISTERED INJECTIONS
NONCORING NEEDLE OR STYLET WITH OR WITHOUT CATHETE
SYRINGE, STERILE, 20 CC OR GREATER, EACH
NEEDLES ONLY, STERILE, ANY SIZE, EACH
STERILE WATER/SALINE, 10 ML
STERILE WATER/SALINE, 500 ML
Sterile saline or water, metered dose dispenser, 1
REFILL KIT FOR IMPLANTABLE INFUSION PUMP
SUPPLIES FOR MAINTENANCE OF DRUG INFUSION CATHETER
INFUSION SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP,
INFUSION SUPPLIES NOT USED WITH EXTERNAL INFUSION
INFUSION SET FOR EXTERNAL INSULIN PUMP, NON NEEDLE
INFUSION SET FOR EXTERNAL INSULIN PUMP, NEEDLE TYP
SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STE
REPLACEMENT BATTERY, ALKALINE - OTHER THAN J CELL
Replacement battery, alkaline, j cell, for use wit
Replacement battery, lithium, for use with medical
Replacement battery, silver oxide, for use with me
ALCOHOL OR PEROXIDE, PER PINT
ALCOHOL WIPES, PER BOX
BETADINE OR PHISOHEX SOLUTION, PER PINT
BETADINE OR IODINE SWABS/WIPES, PER BOX
CHLORHEXIDINE CONTAINING ANTISEPTIC, 1 ML
URINE TEST OR REAGENT STRIPS OR TABLETS (100 TABLE
BLOOD KETONE TEST OR REAGENT STRIP EACH
BLOOD GLUCOSE TEST OR REAGENT STRIPS FOR HOME BLOO
PLATFORMS FOR HOME BLOOD GLUCOSE MONITOR, 50 PER B
NORMAL, LOW, HIGH CALIBRATOR SOLUTION/CHIPS
SPRING-POWERED DEVICE FOR LANCET, EACH
LANCETS, PER BOX OF 100
CERVICAL CAP FOR CONTRACEPTIVE USE
PERMANENT, LONG TERM, NON-DISSOLVABLE LACRIMAL DUC
PERM IMPL CONTRACEPTIVE TUBAL OCCL DEV & DEL SYS
PARAFFIN, PER POUND
DIAPHRAGM FOR CONTRACEPTIVE USE
CONTRACEPTIVE SUPPLY, CONDOM, MALE, EACH
CONTRACEPTIVE SUPPLY, CONDOM, FEMALE, EACH
CONTRACEPTIVE SUPPLY, SPERMICIDE (E.G., FOAM, GEL)
DISPOSABLE ENDOSCOPE SHEATH, EACH
ADHESIVE SKIN SUPPORT ATTACHMENT FOR USE WITH EXTE
TUBING FOR BREAST PUMP, REPLACEMENT
ADAPTER FOR BREAST PUMP, REPLACEMENT
CAP FOR BREAST PUMP BOTTLE, REPLACEMENT
BREAST SHIELD AND SPLASH PROTECTOR FOR USE WITH BR
POLYCARBONATE BOTTLE FOR USE WITH BREAST PUMP, REP
LOCKING RING FOR BREAST PUMP, REPLACEMENT
SACRAL NERVE STIMULATION TEST LEAD, EACH
IMPLANTABLE ACCESS CATHETER, (E,G., VENOUS, ARTERI
IMPLANTABLE ACCESS TOTAL CATHETER, PORT/RESERVOIR
DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 50 M
DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 5 ML
INSERTION TRAY WITHOUT DRAINAGE BAG AND WITHOUT CA
INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLIN
INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLIN
INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLIN
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2013
1/1/2013
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
A4314
A4315
A4316
A4320
A4321
A4322
A4326
A4327
A4328
A4330
A4331
A4332
A4333
A4334
A4335
A4336
A4337
A4338
A4340
A4344
A4346
A4349
A4351
A4352
A4353
A4354
A4355
A4356
A4357
A4358
A4360
A4361
A4362
A4363
A4364
A4366
A4367
A4368
A4369
A4371
A4372
A4373
A4375
A4376
A4377
A4378
A4379
A4380
A4381
A4382
A4383
A4384
A4385
A4387
A4388
A4389
A4390
A4391
A4392
A4393
A4394
A4395
A4396
A4397
A4398
A4399
A4400
A4402
A4404
A4405
A4406
A4407
A4408
A4409
A4410
A4411
A4412
A4413
A4414
A4415
A4416
A4417
A4418
A4419
A4420
A4421
A4422
A4423
A4424
A4425
A4426
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING C
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING C
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING C
IRRIGATION TRAY WITH BULB OR PISTON SYRINGE, ANY P
THERAPEUTIC AGENT FOR URINARY CATHETER IRRIGATION
IRRIGATION SYRINGE, BULB OR PISTON, EACH
MALE EXTERNAL CATHETER SPECIALTY TYPE WITH INTEGRA
FEMALE EXTERNAL URINARY COLLECTION DEVICE MEATAL
FEMALE EXTERNAL URINARY COLLECTION DEVICE POUCH,
PERIANAL FECAL COLLECTION POUCH WITH ADHESIVE, EAC
EXTENSION DRAINAGE TUBING, ANY TYPE, ANY LENGTH, W
LUBRICANT, INDIVIDUAL STERILE PACKET, EACH
URINARY CATHETER ANCHORING DEVICE, ADHESIVE SKIN A
URINARY CATHETER ANCHORING DEVICE, LEG STRAP, EACH
INCONTINENCE SUPPLY; MISCELLANEOUS
INCONTINENCE SUPPLY URETHRAL INSERT ANY TYPE EA
INCONTINENCE SUPPLY, RECTAL INSERT, ANY TYPE, EACH
INDWELLING CATHETER; FOLEY TYPE, TWO-WAY LATEX WIT
INDWELLING CATHETER; SPECIALTY TYPE, EG COUDE, M
INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILI
INDWELLING CATHETER; FOLEY TYPE, THREE WAY FOR CON
MALE EXTERNAL CATHETER, WITH OR WITHOUT ADHESIVE,
INTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH
INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP,
INTERMITTENT URINARY CATHETER, WITH INSERTION SUPP
INSERTION TRAY WITH DRAINAGE BAG BUT WITHOUT CATHE
IRRIGATION TUBING SET FOR CONTINUOUS BLADDER IRRIG
EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE (NOT
BEDSIDE DRAINAGE BAG, DAY OR NIGHT, WITH OR WITHOU
URINARY DRAINAGE BAG, LEG OR ABDOMEN, VINYL, WITH
DISPSBL EXT URETHRAL CLAMP/COMP DEV PAD POUCH EA
OSTOMY FACEPLATE, EACH
SKIN BARRIER; SOLID, 4 X 4 OR EQUIVALENT; EACH
OSTOMY CLAMP, ANY TYPE, REPLACEMENT ONLY, EACH
ADHESIVE, LIQUID OR EQUAL, ANY TYPE, PER OZ
OSTOMY VENT, ANY TYPE, EACH
OSTOMY BELT, EACH
OSTOMY FILTER, ANY TYPE, EACH
OSTOMY SKIN BARRIER, LIQUID (SPRAY, BRUSH, ETC), P
OSTOMY SKIN BARRIER, POWDER, PER OZ
OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, WIT
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE
OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED,
OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED,
OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, PLA
OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, RUB
OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, PL
OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, RU
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, PLAST
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, HEAVY
OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, RUBBE
OSTOMY FACEPLATE EQUIVALENT, SILICONE RING, EACH
OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTE
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIE
OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WI
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIE
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER
OSTOMY POUCH, URINARY, WITH STANDARD WEAR BARRIER
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER
OSTOMY DEODORANT FOR USE IN OSTOMY POUCH, LIQUID,
OSTOMY DEODORANT FOR USE IN OSTOMY POUCH, SOLID, P
OSTOMY BELT WITH PERISTOMAL HERNIA SUPPORT
IRRIGATION SUPPLY; SLEEVE, EACH
OSTOMY IRRIGATION SUPPLY; BAG, EACH
OSTOMY IRRIGATION SUPPLY; CONE/CATH W/WO BRUSH
OSTOMY IRRIGATION SET
LUBRICANT, PER OUNCE
OSTOMY RING, EACH
OSTOMY SKIN BARRIER, NON-PECTIN BASED, PASTE, PER
OSTOMY SKIN BARRIER, PECTIN-BASED, PASTE, PER OUNC
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE,
OSTOMY SKIN BARRIER, WTIH FLANGE (SOLID, FLEXIBLE
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, 4X4 OR EQ
OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A
OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH
OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH
OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED, WI
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH NONOSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCK
OSTOMY SUPPLY; MISCELLANEOUS
OSTOMY ABSORBENT MATERIAL (SHEET/PAD/CRYSTAL PACKE
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCK
OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WI
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH N
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH L
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
A4427
A4428
A4429
A4430
A4431
A4432
A4433
A4434
A4435
A4450
A4452
A4455
A4456
A4458
A4459
A4461
A4463
A4465
A4466
A4470
A4480
A4481
A4483
A4490
A4495
A4500
A4510
A4520
A4550
A4554
A4555
A4556
A4557
A4558
A4559
A4561
A4562
A4565
A4566
A4570
A4575
A4580
A4590
A4595
A4600
A4601
A4602
A4604
A4605
A4606
A4608
A4611
A4612
A4613
A4614
A4615
A4616
A4617
A4618
A4619
A4620
A4623
A4624
A4625
A4626
A4627
A4628
A4629
A4630
A4633
A4634
A4635
A4636
A4637
A4638
A4639
A4640
A4641
A4642
A4648
A4649
A4650
A4651
A4652
A4653
A4657
A4660
A4663
A4670
A4671
A4672
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH L
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER
OSTOMY POUCH, URINARY, WITH BARRIER ATTACHED, WITH
OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER
OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED, WITH
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH NON
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOC
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOC
OST POUCH DRAIN HI OP EXT WEAR BARR W/WO FLTR EA
TAPE, NON-WATERPROOF, PER 18 SQUARE INCHES
TAPE, WATERPROOF, PER 18 SQUARE INCHES
ADHESIVE REMOVER OR SOLVENT (FOR TAPE, CEMENT OR O
ADHESIVE REMOVER WIPES ANY TYPE EACH
ENEMA BAG WITH TUBING, REUSABLE
MANUAL PUMP-OPERATED ENEMA SYS REUSABLE ANY TYPE
SURGICAL DRESS HOLD NON-REUSE
SURGICAL DRESSING HOLDER, REUSE
NON-ELASTIC BINDER FOR EXTREMITY
GARMENT BELT SLEEVE OR OTH COVERING ELASTIC EACH
GRAVLEE JET WASHER
VABRA ASPIRATOR
TRACHEOSTOMA FILTER, ANY TYPE, ANY SIZE, EACH
MOISTURE EXCHANGER, DISPOSABLE, FOR USE WITH INVAS
SURGICAL STOCKINGS ABOVE KNEE LENGTH, EACH
SURGICAL STOCKINGS THIGH LENGTH, EACH
SURGICAL STOCKINGS BELOW KNEE LENGTH, EACH
SURGICAL STOCKINGS FULL LENGTH, EACH
INCONTINENCE GARMENT, ANY TYPE, (E.G. BRIEF, DIAPE
SURGICAL TRAYS
DISPOSABLE UNDERPADS, ALL SIZES, (E.G., CHUXS)
ELECTRD/TRANSDUCR E-STIM DVC USED CA TX RPL ONLY
ELECTRODES, (E.G., APNEA MONITOR), PER PAIR
LEAD WIRES, (E.G., APNEA MONITOR), PER PAIR
CONDUCTIVE PASTE OR GEL
COUPLING GEL OR PASTE
PESSARY, RUBBER, ANY TYPE
PESSARY, NON RUBBER, ANY TYPE
SLINGS
SHOULDER SLING/VEST ABDUCTION RESTRAINER PREFAB
SPLINT
TOPICAL HYPERBARIC OXYGEN CHAMBER, DISPOSABLE
CAST SUPPLIES (E.G. PLASTER)
SPECIAL CASTING MATERIAL (E.G. FIBERGLASS)
ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH,
Sleeve, inter limb comp dev
LITHIUM ION BATT RECHARG NONPROS USE REPLACEMENT
REPL BA EXT INFUS PUMP OWND PATIENT LI 1.5 V EA
TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH
TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, EACH
OXYGEN PROBE FOR USE WITH OXIMETER DEVICE, REPLACE
TRANSTRACHEAL OXYGEN CATHETER, EACH
BATTERY, HEAVY DUTY; REPLACEMENT FOR PATIENT OWNED
BATTERY CABLES; REPLACEMENT FOR PATIENT-OWNED VENT
BATTERY CHARGER; REPLACEMENT FOR PATIENT-OWNED VEN
PEAK EXPIRATORY FLOW RATE METER, HAND HELD
CANNULA, NASAL
TUBING (OXYGEN), PER FOOT
MOUTH PIECE
BREATHING CIRCUITS
FACE TENT
VARIABLE CONCENTRATION MASK
TRACHEOSTOMY, INNER CANNULA
TRACHEAL SUCTION CATHETER, ANY TYPE OTHER THAN CLO
TRACHEOSTOMY CARE KIT FOR NEW TRACHEOSTOMY
TRACHEOSTOMY CLEANING BRUSH, EACH
SPACER, BAG OR RESERVOIR, WITH OR WITHOUT MASK, FO
OROPHARYNGEAL SUCTION CATHETER, EACH
TRACHEOSTOMY CARE KIT FOR ESTABLISHED TRACHEOSTOMY
REPLACEMENT BATTERIES. MEDICALLY NECESSARY T.E.N.
REPLACEMENT BULB/LAMP FOR ULTRAVIOLET LIGHT THERAP
REPLACEMENT BULB FOR THERAPEUTIC LIGHT BOX, TABLET
UNDERARM PAD, CRUTCH, REPLACEMENT, EACH
REPLACEMENT, HANDGRIP, CANE, CRUTCH, OR WALKER, EA
REPLACEMENT, TIP, CANE, CRUTCH, WALKER, EACH.
REPLACEMENT BATTERY FOR PATIENT-OWNED EAR PULSE GE
REPLACEMENT PAD FOR INFRARED HEATING PAD SYSTEM, E
REPLACEMENT PAD FOR USE WITH MEDICALLY NECESSARY
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
SUPPLY OF SATUMOMAB PENDETIDE, RADIOPHARMACEUTICAL
TISSUE MARKER IMPLANTABLE ANY TYPE EACH
SURGICAL SUPPLY; MISCELLANEOUS
IMPLANTABLE RADIATION DOSIMETER EACH
CALIBRATED MICROCAPILLARY TUBE, EACH
MICROCAPILLARY TUBE SEALANT
PERITONEAL DIALYSIS CATHETER ANCHORING DEVICE, BEL
SYRINGE, WITH OR WITHOUT NEEDLE, EACH
SPHYGMOMANOMETER/BLOOD PRESSURE APPARATUS WITH CUF
BLOOD PRESSURE CUFF ONLY
AUTOMATIC BLOOD PRESSURE MONITOR
DISPOSABLE CYCLER SET USED WITH CYCLER DIALYSIS MA
DRAINAGE EXTENSION LINE, STERILE, FOR DIALYSIS, EA
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2015
1/1/2007
1/1/2007
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2015
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
A4673
A4674
A4680
A4690
A4706
A4707
A4708
A4709
A4714
A4719
A4720
A4721
A4722
A4723
A4724
A4725
A4726
A4728
A4730
A4736
A4737
A4740
A4750
A4755
A4760
A4765
A4766
A4770
A4771
A4772
A4773
A4774
A4802
A4860
A4870
A4890
A4911
A4913
A4918
A4927
A4928
A4929
A4930
A4931
A4932
A5051
A5052
A5053
A5054
A5055
A5056
A5057
A5061
A5062
A5063
A5071
A5072
A5073
A5081
A5082
A5083
A5093
A5102
A5105
A5112
A5113
A5114
A5120
A5121
A5122
A5126
A5131
A5200
A5500
A5501
A5503
A5504
A5505
A5506
A5507
A5508
A5510
A5512
A5513
A6000
A6010
A6011
A6021
A6022
A6023
A6024
EXTENSION LINE WITH EASY LOCK CONNECTORS, USED WIT
CHEMICALS/ANTISEPTICS SOLUTION USED TO CLEAN/STERI
ACTIVATED CARBON FILTER FOR HEMODIALYSIS, EACH
DIALYZER (ARTIFICIAL KIDNEYS), ALL TYPES, ALL SIZE
BICARBONATE CONCENTRATE, SOLUTION, FOR HEMODIALYSI
BICARBONATE CONCENTRATE, POWDER, FOR HEMODIALYSIS,
ACETATE CONCENTRATE SOLUTION, FOR HEMODIALYSIS, PE
ACID CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER
TREATED WATER (DEIONIZED, DISTILLED, OR REVERSE OS
Y SET TUBING FOR PERITONEAL DIALYSIS
DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE,
DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE,
DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE,
DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE,
DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE,
DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE,
DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE,
DIALYSATE SOLUTION, NON-DEXTROSE CONTAINING, 500 M
FISTULA CANNULATION SET FOR HEMODIALYSIS, EACH
TOPICAL ANESTHETIC, FOR DIALYSIS, PER GRAM
INJECTABLE ANESTHETIC, FOR DIALYSIS, PER 10 ML
SHUNT ACCESSORY, FOR HEMODIALYSIS, ANY TYPE, EACH
BLOOD TUBING, ARTERIAL OR VENOUS, FOR HEMODIALYSIS
BLOOD TUBING, ARTERIAL AND VENOUS COMBINED, FOR HE
DIALYSATE SOLUTION TEST KIT, FOR PERITONEAL DIALYS
DIALYSATE CONCENTRATE, POWDER, ADDITIVE FOR PERITO
DIALYSATE CONCENTRATE, SOLUTION, ADDITIVE FOR PERI
BLOOD COLLECTION TUBE, VACUUM, FOR DIALYSIS, PER 5
SERUM CLOTTING TIME TUBE, FOR DIALYSIS, PER 50
BLOOD GLUCOSE TEST STRIPS, FOR DIALYSIS, PER 50
OCCULT BLOOD TEST STRIPS, FOR DIALYSIS, PER 50
AMMONIA TEST STRIPS, FOR DIALYSIS, PER 50
PROTAMINE SULFATE, FOR HEMODIALYSIS, PER 50 MG
DISPOSABLE CATHETER TIPS FOR PERITONEAL DIALYSIS,
PLUMBING AND/OR ELECTRICAL WORK FOR HOME HEMODIALY
CONTRACTS, REPAIR AND MAINTENANCE, FOR HEMODIALYSI
DRAIN BAG/BOTTLE, FOR DIALYSIS, EACH
MISCELLANEOUS DIALYSIS SUPPLIES, NOT OTHERWISE SPE
VENOUS PRESSURE CLAMP, FOR HEMODIALYSIS, EACH
GLOVES, NON-STERILE, PER 100
SURGICAL MASK, PER 20
TOURNIQUET FOR DIALYSIS, EACH
GLOVES, STERILE, PER PAIR
ORAL THERMOMETER, REUSABLE, ANY TYPE, EACH
RECTAL THERMOMETER, REUSABLE, ANY TYPE, EACH
OSTOMY POUCH, CLOSED; WITH BARRIER ATTACHED (1 PIE
OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED (1
OSTOMY POUCH, CLOSED; FOR USE ON FACEPLATE, EACH
OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH FLAN
STOMA CAP
OST POUCH DRAINABLE EXT WEAR BARRIER W/FILTER EA
OST POUCH DRAINABL EXT WEAR BARR CONVXTY FLTR EA
OSTOMY POUCH, DRAINABLE; WITH BARRIER ATTACHED, (1
OSTOMY POUCH, DRAINABLE; WITHOUT BARRIER ATTACHED
OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH F
OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED (1 PI
OSTOMY POUCH, URINARY; WITHOUT BARRIER ATTACHED (1
OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH FLA
STOMA PLUG OR SEAL ANY TYPE
CONTINENT DEVICE; CATHETER FOR CONTINENT STOMA
CONTINENT DEVICE STOMA ABSORPTIVE COVER STOMA
OSTOMY ACCESSORY; CONVEX INSERT
BEDSIDE DRAINAGE BOTTLE WITH OR WITHOUT TUBING, RI
URINARY SUSPENSORY; WITH LEG BAG, WITH OR WITHOUT
URINARY DRAINAGE BAG LEG OR ABDOMEN LATEX EACH
LEG STRAP; LATEX, REPLACEMENT ONLY, PER SET
LEG STRAP; FOAM OR FABRIC, REPLACEMENT ONLY, PER
SKIN BARRIER, WIPES OR SWABS, EACH
SKIN BARRIER; SOLID, 6 X 6 OR EQUIVALENT, EACH
SKIN BARRIER; SOLID, 8 X 8 OR EQUIVALENT, EACH
ADHESIVE OR NON-ADHESIVE; DISK OR FOAM PAD
APPLIANCE CLEANER, INCONTINENCE AND OSTOMY APPLIAN
PERCUTANEOUS CATHETER/TUBE ANCHORING DEVICE, ADHES
FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP),
FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP),
FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTIN
FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTIN
FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTIN
FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTIN
FOR DIABETICS ONLY, NOT OTHERWISE SPECIFIED MODIFI
FOR DIABETICS ONLY, DELUXE FEATURE OF OFF-THE-SHEL
FOR DIABETICS ONLY, DIRECT FORMED, COMPRESSION MOL
For diabetics only, multiple density insert, direc
FOR DIABETICS ONLY,MULTIPLE DENSITY INSERT,CUSTOM
NON-CONTACT WOUND WARMING WOUND COVER FOR USE WITH
COLLAGEN BASED WOUND FILLER, DRY FORM, PER GRAM OF
COLLEGEN BASED WOUND FILLR GEL/PASTE STERL PER G
COLLAGEN DRESSING, PAD SIZE 16 SQ. IN. OR LESS, EA
COLLAGEN DRESSING, PAD SIZE MORE THAN 16 SQ. IN. B
COLLAGEN DRESSING, PAD SIZE MORE THAN 48 SQ. IN.,
COLLAGEN DRESSING WOUND FILLER, PER 6 INCHES
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
A6025
A6154
A6196
A6197
A6198
A6199
A6203
A6204
A6205
A6206
A6207
A6208
A6209
A6210
A6211
A6212
A6213
A6214
A6215
A6216
A6217
A6218
A6219
A6220
A6221
A6222
A6223
A6224
A6228
A6229
A6230
A6231
A6232
A6233
A6234
A6235
A6236
A6237
A6238
A6239
A6240
A6241
A6242
A6243
A6244
A6245
A6246
A6247
A6248
A6250
A6251
A6252
A6253
A6254
A6255
A6256
A6257
A6258
A6259
A6260
A6261
A6262
A6266
A6402
A6403
A6404
A6407
A6410
A6411
A6412
A6413
A6441
A6442
A6443
A6444
A6445
A6446
A6447
A6448
A6449
A6450
A6451
A6452
A6453
A6454
A6455
A6456
A6457
A6501
A6502
A6503
GEL SHEET FOR DERMAL OR EPIDERMAL APPLICATION, (E.
WOUND POUCH, EACH
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND CO
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND CO
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND CO
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND FI
COMPOSITE DRESSING, PAD SIZE 16 SQ. IN. OR LESS, W
COMPOSITE DRESSING, PAD SIZE MORE THAN 16 SQ. IN.
COMPOSITE DRESSING, PAD SIZE MORE THAN 48 SQ. IN.,
CONTACT LAYER, 16 SQ. IN. OR LESS, EACH DRESSING
CONTACT LAYER, MORE THAN 16 SQ. IN. BUT LESS THAN
CONTACT LAYER, MORE THAN 48 SQ. IN., EACH DRESSING
FOAM DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR
FOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 16
FOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 48
FOAM DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR
FOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 16
FOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 48
FOAM DRESSING, WOUND FILLER, PER GRAM
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE 16 S
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE
GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE
GAUZE, NON-IMPREGNATED, PAD SIZE 16 SQ. IN. OR LES
GAUZE, NON-IMPREGNATED, PAD SIZE MORE THAN 16 SQ.
GAUZE, NON-IMPREGNATED, PAD SIZE MORE THAN 48 SQ.
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL S
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL S
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL S
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, PAD SI
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, PAD SI
GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, PAD SI
GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CON
GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CON
GAUZE, IMPREGNATED, HYDROGEL FOR DIRECT WOUND CONT
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE 16 SQ
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE 16 SQ
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE
HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE
HYDROCOLLOID DRESSING, WOUND FILLER, PASTE, PER FL
HYDROCOLLOID DRESSING, WOUND FILLER, DRY FORM, PER
HYDROGEL DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN
HYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN
HYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN
HYDROGEL DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN
HYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN
HYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN
HYDROGEL DRESSING WOUND FILLER GEL PER FL OZ
SKIN SEALANTS, PROTECTANTS, MOISTURIZERS, OINTMENT
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SI
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SI
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SI
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SI
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SI
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SI
TRANSPARENT FILM, 16 SQ. IN. OR LESS, EACH DRESSIN
TRANSPARENT FILM, MORE THAN 16 SQ. IN. BUT LESS TH
TRANSPARENT FILM, MORE THAN 48 SQ. IN., EACH DRESS
WOUND CLEANSERS ANY TYPE ANY SIZE
WOUND FILLER GEL/PASTE PER FL OZ NOS
WOUND FILLER DRY FORM PER G NOT OTHERWISE SPEC
GAUZE, IMPREGNATED, OTHER THAN WATER, NORMAL SALIN
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. I
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THA
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THA
PACKING STRIPS, NON-IMPREGNATED, UP TO 2 INCHES IN
EYE PAD, STERILE, EACH
EYE PAD, NON-STERILE, EACH
EYE PATCH, OCCLUSIVE, EACH
ADHESIVE BANDAGE FIRST-AID TYPE ANY SIZE EACH
PADDING BANDAGE, NON-ELASTIC, NON-WOVEN/NON-KNITTE
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NO
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NO
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NO
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, ST
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, ST
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, ST
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN,
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN,
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN,
MODERATE COMPRESSION BANDAGE, ELASTIC, KNITTED/WOV
HIGH COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN,
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WO
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WO
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WO
ZINC PASTE IMPREGNATED BANDAGE, NON-ELASTIC, KNITT
TUBULAR DRESSING W/WO ELEASTIC, ANY WIDTH, PER LIN
COMPRESSION BURN GARMENT, BODYSUIT (HEAD TO FOOT),
COMPRESSION BURN GARMENT, CHIN STRAP, CUSTOM FABRI
COMPRESSION BURN GARMENT, FACIAL HOOD, CUSTOM FABR
1/1/2004
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1/1/2008
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1/1/2006
1/1/2004
1/1/2004
1/1/2004
12/31/9999
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12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
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N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
A6504
A6505
A6506
A6507
A6508
A6509
A6510
A6511
A6512
A6513
A6530
A6531
A6532
A6533
A6534
A6535
A6536
A6537
A6538
A6539
A6540
A6541
A6544
A6545
A6549
A6550
A7000
A7001
A7002
A7003
A7004
A7005
A7006
A7007
A7008
A7009
A7010
A7011
A7012
A7013
A7014
A7015
A7016
A7017
A7018
A7020
A7025
A7026
A7027
A7028
A7029
A7030
A7031
A7032
A7033
A7034
A7035
A7036
A7037
A7038
A7039
A7040
A7041
A7044
A7045
A7046
A7047
A7048
A7501
A7502
A7503
A7504
A7505
A7506
A7507
A7508
A7509
A7520
A7521
A7522
A7523
A7524
A7525
A7526
A7527
A8000
A8001
A8002
A8003
A8004
A9150
COMPRESSION BURN GARMENT, GLOVE TO WRIST, CUSTOM F
COMPRESSION BURN GARMENT, GLOVE TO ELBOW, CUSTOM F
COMPRESSION BURN GARMENT, GLOVE TO AXILLA, CUSTOM
COMPRESSION BURN GARMENT, FOOT TO KNEE LENGTH, CUS
COMPRESSION BURN GARMENT, FOOT TO THIGH LENGTH, CU
COMPRESSION BURN GARMENT, UPPER TRUNK TO WAIST INC
COMPRESSION BURN GARMENT, TRUNK, INCLUDING ARMS DO
COMPRESSION BURN GARMENT, LOWER TRUNK INCLUDING LE
COMPRESSION BURN GARMENT, NOT OTHERWISE CLASSIFIED
COMPRESSION BURN MASK,FACE AND/OR NEC, PLASTICS
Gradient compression stocking, below knee,
GRADIENT COMPRESSION STOCKING, BELOW KNEE
GRADIENT COMPRESSION STOCKING, BELOW KNEE
GRADIENT COMPRESSION STOCKING, THIGH LENGTH
GRADIENT COMPRESSION STOCKING, THIGH LENGTH
GRADIENT COMPRESSION STOCKING, THIGH LENGTH
GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP ST
GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP ST
GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP ST
GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30
GRADIENT COMPRESSION STOCKING,WAIST LENGTH, 30-40GRADIENT COMPRESSION STOCKING, WAIST LEGNTH, 40-50
GRADIENT COMPRESSION STOCKING, GARTER BELT
GRADIENT COMPRS WRAP NONELAST BK 30-50 MM HG EA
GRADIENT COMPRESSION STOCKING/SLEEVE NOS
DRESSING SET FOR NEGATIVE PRESSURE WOUND THERAPY E
CANISTER, DISPOSABLE, USED WITH SUCTION PUMP, EACH
CANISTER, NON-DISPOSABLE, USED WITH SUCTION PUMP,
TUBING, USED WITH SUCTION PUMP, EACH
ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED
SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, DISP
ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED
ADMINISTRATION SET, WITH SMALL VOLUME FILTERED PNE
LARGE VOLUME NEBULIZER, DISPOSABLE, UNFILLED, USED
LARGE VOLUME NEBULIZER, DISPOSABLE, PREFILLED, USE
RESERVOIR BOTTLE, NON-DISPOSABLE, USED WITH LARGE
CORRUGATED TUBING, DISPOSABLE, USED WITH LARGE VOL
CORRUGATED TUBING, NON-DISPOSABLE, USED WITH LARGE
WATER COLLECTION DEVICE, USED WITH LARGE VOLUME NE
FILTER DISPOSABL W/AREOSOL COMPRESS/US GENERATOR
FILTER, NONDISPOSABLE, USED WITH AEROSOL COMPRESSO
AEROSOL MASK, USED WITH DME NEBULIZER
DOME AND MOUTHPIECE, USED WITH SMALL VOLUME ULTRAS
NEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC,
WATER, DISTILLED, USED WITH LARGE VOLUME NEBULIZER
INTERFACE COUGH STIMULAT DEVC REPLACEMENT ONLY
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM VEST,
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM HOSE,
COMB ORAL/NASAL MASK USED W/CPAP DEVICE EACH
ORAL CUSHION COMB ORAL/NASAL MASK REPL ONLY EACH
NASAL PILLOWS COMB ORAL/NASL MASK REPL ONLY PAIR
FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE
FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MAS
REPLACEMENT CUSHION FOR NASAL APPLICATION DEVICE,
REPLACEMENT PILLOWS FOR NASAL APPLICATION DEVICE,
NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH P
HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE
CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE DEVIC
TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE
FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRES
FILTER, NON DISPOSABLE, USED WITH POSITIVE AIRWAY
ONE WAY CHEST DRAIN VALVE
WATER SEAL DRAINAGE CONTAINER AND TUBING FOR USE W
ORAL INTERFACE USED WITH POSITIVE AIRWAY PRESSURE
EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH A
WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE A
ORAL INTERFACE USED RESPIRATORY SUCTION PUMP EA
VACUUM DRAINAGE COLLECTION UNIT & TUBING KIT EA
TRACHEOSTOMA VALVE, INCLUDING DIAPHRAGM, EACH
REPLACEMENT DIAPHRAGM/FACEPLATE FOR TRACHEOSTOMA V
FILTER HOLDER OR FILTER CAP, REUSABLE, FOR USE IN
FILTER FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE
HOUSING, REUSABLE WITHOUT ADHESIVE, FOR USE IN A H
ADHESIVE DISC FOR USE IN A HEAT AND MOISTURE EXCHA
FILTER HOLDER AND INTEGRATED FILTER WITHOUT ADHESI
HOUSING AND INTEGRATED ADHESIVE, FOR USE IN A TRAC
FILTER HOLDER AND INTEGRATED FILTER HOUSING, AND A
TRACHEOSTOMY/LARYNGECTOMY TUBE, NON-CUFFED, POLYVI
TRACHEOSTOMY/LARYNGECTOMY TUBE, CUFFED, POLYVINYLC
TRACHEOSTOMY/LARYNGECTOMY TUBE, STAINLESS STEEL OR
TRACHEOSTOMY SHOWER PROTECTOR, EACH
TRACHEOSTOMA STENT/STUD/BUTTON, EACH
TRACHEOSTOMY MASK, EACH
TRACHEOSTOMY TUBE COLLAR/HOLDER, EACH
TRACHEOSTOMY/LARYNGECTOMY TUBE PLUG/STOP, EACH
Soft protect helmet prefab
Hard protect helmet prefab
Soft protect helmet custom
Hard protect helmet custom
Repl soft interface, helmet
NON-PRESCRIPTION DRUGS
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
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1/1/2006
1/1/2006
1/1/2006
1/1/2006
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1/1/2006
1/1/2009
1/1/2006
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2015
1/1/2004
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1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
Y
N
N
N
Y
Y
Y
Y
N
Y
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
A9152
A9153
A9155
A9180
A9270
A9272
A9273
A9274
A9275
A9276
A9277
A9278
A9279
A9280
A9282
A9283
A9284
A9300
A9500
A9501
A9502
A9503
A9504
A9505
A9507
A9508
A9509
A9510
A9512
A9516
A9517
A9520
A9521
A9524
A9526
A9527
A9528
A9529
A9530
A9531
A9532
A9537
A9538
A9539
A9540
A9541
A9547
A9552
A9555
A9558
A9560
A9561
A9562
A9567
A9568
A9569
A9570
A9571
A9572
A9575
A9576
A9577
A9578
A9579
A9580
A9581
A9582
A9583
A9584
A9585
A9586
A9599
A9600
A9604
A9606
A9698
A9699
A9700
A9900
A9901
A9999
B4034
B4035
B4036
B4081
B4082
B4083
B4087
B4088
B4100
B4102
SINGLE VITAMIN/MINERAL/TRACE ELEMENT, ORAL, PER DO
MULTIPLE VITAMINS, WITH OR WITHOUT MINERALS AND TR
ARTFICIAL SALIVA 30 ML
PEDICULOSIS (LICE INFESTATION) TREATMENT, TOPICAL,
NON-COVERED ITEM OR SERVICE
WND SUCT DISPBL DSG ALL ACC & CMPNT ANY TYP EA
HOT WATER BOTTLE ICE CAP OR COLLAR ANY TYPE
EXTERNAL AMB INSULIN DEL SYSTEM DISPOSABLE EA
HOME GLUCOSE DISPOSABLE MONITOR, INCLUDES TEST STRIPS.
SENSOR;INVSV DISP INTRSTL CONT GLU MON SYS 1U=1D
TRANSMITTER; EXT INTERSTITIAL CONT GLU MON SYS
RECEIVER MON; EXT INTERSTITIAL CONT GLU MON SYS
Monitoring feature/deviceNOC
ALERT OR ALARM DEVICE, NOT OTHERWISE CLASSIFIED
WIG, ANY TYPE, EACH
FOOT PRESSURE OFF LOAD/SUPP DEVICE ANY TYPE EACH
SPIROMETER NONELECTRONIC INCL ALL ACCESSORIES
EXERCISE EQUIPMENT
TECHNETIUM TC-99M SESTAMIBI DX PER STUDY DOSE
TECHNETIUM TC-99M TEBOROXIME DX PER STUDY DOSE
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
IODINE I-123 SODIUM IODIDE DX PER MILLICURIE
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING
TECHNETIUM TC-99M TILMANOCEPT DX TO 0.5 MCI
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING A
Iodine I-125 sodium iodide
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC AGENT, ISUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC AGENT, ISUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC AGENT, I
SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC AGENT, ISUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC AGENT, I
Technetium tc-99m mebrofenin, diagnostic, per stud
TECHMETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUD
TECHNETIUM 99M PENTETATE DIAG PER STUDY DOSE UP TO 25 MILLICURIES
TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN, DIAG, PER STUDY DOES, UP TO 10 MILL
TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER
Indium in-111 oxyquinoline, diagnostic, per 0.5 mi
Fluorodeoxyglucose f-s8 fdg, diagnostic, per study
RUBIDIUM RB-82 DIAGNOSTIC PER STUDY DOSE UP TO 60 MILLICURIES
XENON XE-133 GAS, DIAGNOSTIC, PER 10 MILLICURIES
COBALT TC-99M LABELED RED BLOOD CELLS, DIAGNOSTIC,
Technetium tc-99m oxidronate, diagnostic, per stud
Technetium tc-99m oxidronate, diagnostic
TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, AEROSOL, PER STUDY DOSE, UP TO 75 MILLCU
Technetium tc99m arcitumomab
TECHNETIUM TC-99M EXAMETAZIME AUTOLG WBC DX DOSE
INDIUM IN-111 AUTOLOGOUS WBC DX PER STUDY DOSE
INDIUM IN-111 AUTOLOGOUS PLATELETS DX STUDY DOSE
INDIUM IN-111 PENTETREOTIDE DX DOSE TO 6 MCI
INJECTION GADOTERATE MEGLUMINE 0.1 ML
INJECTION GADOTERIDOL PROHANCE MULTIPACK PER ML
INJ GADOBENATE DIMEGLUMINE MULTIHANCE PER ML
INJ GADOBENATE DIMEGLUMINE MXHANCE MXPACK PER ML
INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CON
SODIUM FLUORIDE F-18 DX PER STUDY DOSE TO 30 MCI
INJECTION GADOXETATE DISODIUM 1 ML
IODINE I-123 IOBENGUANE DX STUDY DOSE TO 15 MCI
INJECTION GADOFOSVESET TRISODIUM 1 ML
IODINE I-123 IOFLUPANE DX-STUDY DOSE UP 5 MCI
INJECTION GADOBUTROL 0.1 ML
FLORBETAPIR F18 DX PER STUDY DOSE UP TO 10 MCI
RADIOPHRM DX BETA-AMYLOID PET IMAG PER STDY DOSE
SUPPLY OF THERAPEUTIC RADIOPHARMACEUTICAL, STRONTI
SAMARIUM SM-153 LEXIDRONAM TX DOSE TO 150 MCI
RADIUM RA-223 DICHLORIDE THERAPEUTIC PER UCI
NON-RADIOACTIVE CONTRAST IMAGING MATERIAL, NOT OTHERWISE CLASSIFIED, PER STUDY
SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING
SUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN
MISCELLANEOUS DME SUPPLY, ACCESSORY, AND/OR SERVIC
DME DELIVERY, SET UP, AND/OR DISPENSING SERVICE CO
MISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT OTHERWI
ENTERAL FEEDING SUPPLY KIT; SYRINGE FED PER DAY
ENTERAL FEEDING SUPPLY KIT; PUMP FED PER DAY
ENTERAL FEEDING SUPPLY KIT; GRAVITY FED PER DAY
NASOGASTRIC TUBING WITH STYLET
NASOGASTRIC TUBING WITHOUT STYLET
STOMACH TUBE - LEVINE TYPE
GASTROSTOMY/J-TUBE STANDARD ANY MATERIAL/TYPE EA
GASTROSTOMY/J-TUBE LOW-PROFILE ANY MAT/TYPE EACH
FOOD THICKENER, ADMINISTERED ORALLY, PER OUNCE
ENTERAL FORMULA, FOR ADULTS, USED TO REPLACE FLUID
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2012
1/1/2011
1/1/2008
1/1/2013
1/1/2008
1/1/2008
1/1/2008
1/1/2007
1/1/2004
1/1/2007
1/1/2008
1/1/2009
1/1/2004
1/1/2010
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2014
1/1/2007
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2014
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2009
1/1/2010
1/1/2010
1/1/2010
1/1/2012
1/1/2012
1/1/2013
1/1/2014
1/1/2004
1/1/2010
1/1/2015
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
B4103
B4104
B4149
B4150
B4152
B4153
B4154
B4155
B4157
B4158
B4159
B4160
B4161
B4162
B4164
B4168
B4172
B4176
B4178
B4180
B4185
B4189
B4193
B4197
B4199
B4216
B4220
B4222
B4224
B5000
B5100
B5200
B9000
B9002
B9004
B9006
B9998
B9999
C1713
C1714
C1715
C1716
C1717
C1719
C1721
C1722
C1724
C1725
C1726
C1727
C1728
C1729
C1730
C1731
C1732
C1733
C1749
C1750
C1751
C1752
C1753
C1754
C1755
C1756
C1757
C1758
C1759
C1760
C1762
C1763
C1764
C1765
C1766
C1767
C1768
C1769
C1770
C1771
C1772
C1773
C1776
C1777
C1778
C1779
C1780
C1781
C1782
C1783
C1784
C1785
C1786
ENTERAL FORMULA, FOR PEDIATRICS, USED TO REPLACE F
ADDITIVE FOR ENTERAL FORMULA (E.G. FIBER)
ENTERAL FORMULA, BLENDERIZED NATURAL FOODS WITH IN
ENTERAL FORMULA, NUTRITIONALLY COMPLETE WITH INTAC
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, CALORICAL
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, HYDROLYZE
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECI
ENTERAL FORMULA, NUTRITIONALLY INCOMPLETE/MODULAR
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECI
ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COM
ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COM
ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COM
ENTERAL FORMULA, FOR PEDIATRICS, HYDROLYZED/AMINO
ENTERAL FORMULA, FOR PEDIATRICS, SPECIAL METABOLIC
PARENTERAL NUTRITION SOLUTION: CARBOHYDRATES (DEX
PARENTERAL NUTRITION SOLUTION; AMINO ACID, 3.5 PER
PARENTERAL NUTRITION SOLUTION; AMINO ACID, 5.5 PER
PARENTERAL NUTRITION SOLUTION; AMINO ACID, 7 PER C
PARENTERAL NUTRITION SOLUTION: AMINO ACID, GREATER
PARENTERAL NUTRITION SOLUTION; CARBOHYDRATES (DEXT
Parenteral nutrition solution, per 10 grams lipids
PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO AC
PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO AC
PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO AC
PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO AC
PARENTERAL NUTRITION; ADDITIVES (VITAMINS, TRACE E
PARENTERAL NUTRITION SUPPLY KIT; PREMIX, PER DAY
PARENTERAL NUTRITION SUPPLY KIT; HOME MIX, PER DAY
PARENTERAL NUTRITION ADMINISTRATION KIT, PER DAY
PARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO A
PARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO AC
PARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO A
ENTERAL NUTRITION INFUSION PUMP - WITHOUT ALARM
ENTERAL NUTRITION INFUSION PUMP - WITH ALARM
PARENTERAL NUTRITION INFUSION PUMP, PORTABLE
PARENTERAL NUTRITION INFUSION PUMP, STATIONARY
NOC FOR ENTERAL SUPPLIES
NOC FOR PARENTERAL SUPPLIES
ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TIS
CATHETER, TRANSLUMINAL ATHERECTOMY, DIRECTIONAL
BRACHYTHERAPY NEEDLE
BRACHYTHERAPY SOURCE, GOLD 198, PER SOURCE
BRACHYTHERAPY SOURCE, HIGH DOSE RATE IRIDIUM 192,
BRACHYTHERAPY SOURCE, NON-HIGH DOSE RATE IRIDIUM 1
CARDIOVERTER-DEFIBRILLATOR, DUAL CHAMBER (IMPLANTA
CARDIOVERTER-DEFIBRILLATOR, SINGLE CHAMBER (IMPLAN
CATHETER, TRANSLUMINAL ATHERECTOMY, ROTATIONAL
CATHETER, TRANSLUMINAL ANGIOPLASTY, NON-LASER (MAY
CATHETER, BALLOON DILATATION, NON-VASCULAR
CATHETER, BALLOON TISSUE DISSECTOR, NON-VASCULAR (
CATHETER, BRACHYTHERAPY SEED ADMINISTRATION
CATHETER, DRAINAGE
CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THA
CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THA
CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION,
CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION,
ENDO RETRO IMAG/ILLUMINATION COLONOSCOPE DEVICE
CATHETER, HEMODIALYSIS, LONG-TERM
CATHETER, INFUSION, INSERTED PERIPHERALLY, CENTRAL
CATHETER, HEMODIALYSIS, SHORT-TERM
CATHETER, INTRAVASCULAR ULTRASOUND
CATHETER, INTRADISCAL
CATHETER, INTRASPINAL
CATHETER, PACING, TRANSESOPHAGEAL
CATHETER, THROMBECTOMY/EMBOLECTOMY
CATHETER, URETERAL
CATHETER, INTRACARDIAC ECHOCARDIOGRAPHY
CLOSURE DEVICE, VASCULAR (IMPLANTABLE/INSERTABLE)
CONNECTIVE TISSUE, HUMAN (INCLUDES FASCIA LATA)
CONNECTIVE TISSUE, NON-HUMAN (INCLUDES SYNTHETIC)
EVENT RECORDER, CARDIAC (IMPLANTABLE)
ADHESION BARRIER
INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPH
GENERATOR, NEUROSTIMULATOR (IMPLANTABLE)
GRAFT, VASCULAR
GUIDE WIRE
IMAGING COIL, MAGNETIC RESONANCE (INSERTABLE)
REPAIR DEVICE, URINARY, INCONTINENCE, WITH SLING G
INFUSION PUMP, PROGRAMMABLE (IMPLANTABLE)
RETRIEVAL DEVICE, INSERTABLE (USED TO RETRIEVE FRA
JOINT DEVICE (IMPLANTABLE)
LEAD, CARDIOVERTER-DEFIBRILLATOR, ENDOCARDIAL SING
LEAD, NEUROSTIMULATOR (IMPLANTABLE)
LEAD, PACEMAKER, TRANSVENOUS VDD SINGLE PASS
LENS, INTRAOCULAR (NEW TECHNOLOGY)
MESH (IMPLANTABLE)
MORCELLATOR
OCULAR IMPLANT, AQUEOUS DRAINAGE ASSIST DEVICE
OCULAR DEVICE, INTRAOPERATIVE, DETACHED RETINA
PACEMAKER, DUAL CHAMBER, RATE-RESPONSIVE (IMPLANTA
PACEMAKER, SINGLE CHAMBER, RATE-RESPONSIVE (IMPLAN
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
10/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
C1787
C1788
C1789
C1813
C1814
C1815
C1816
C1817
C1818
C1819
C1820
C1821
C1822
C1830
C1840
C1841
C1874
C1875
C1876
C1877
C1878
C1880
C1881
C1882
C1883
C1884
C1885
C1886
C1887
C1888
C1891
C1892
C1893
C1894
C1895
C1896
C1897
C1898
C1899
C1900
C2613
C2614
C2615
C2616
C2617
C2618
C2619
C2620
C2621
C2622
C2623
C2624
C2625
C2626
C2627
C2628
C2629
C2630
C2631
C2639
C2644
C2645
C5271
C5272
C5273
C5274
C5275
C5276
C5277
C5278
C8900
C8901
C8902
C8903
C8904
C8905
C8906
C8907
C8908
C8909
C8910
C8911
C8912
C8913
C8914
C8918
C8919
C8920
C8921
C8922
C8923
PATIENT PROGRAMMER, NEUROSTIMULATOR
PORT, INDWELLING (IMPLANTABLE)
PROSTHESIS, BREAST (IMPLANTABLE)
PROSTHESIS, PENILE, INFLATABLE
RETINAL TAMPONADE DEVICE, SILICONE OIL
PROSTHESIS, URINARY SPHINCTER (IMPLANTABLE)
RECEIVER AND/OR TRANSMITTER, NEUROSTIMULATOR (IMPL
SEPTAL DEFECT IMPLANT SYSTEM, INTRACARDIAC
INTEGRATED KERATOPROSTHESIS
SURGICAL TISSUE LOCALIZATION AND EXCISION DEVICE (
GENERATOR NEURO RECHG BAT SYSTEM
Interspinous implant
GENERATOR, NEUROSTIMULATOR (IMPLANTABLE), HIGH FREQUENCY, WITH RECHARGEABLE B
POWERED BONE MARROW BIOPSY NEEDLE
LENS INTRAOCULAR TELESCOPIC
RETINAL PROSTH INCL ALL INTRL & EXTERNL CMPNT
STENT, COATED/COVERED, WITH DELIVERY SYSTEM
STENT, COATED/COVERED, WITHOUT DELIVERY SYSTEM
STENT, NON-COATED/NON-COVERED, WITH DELIVERY SYSTE
STENT, NON-COATED/NON-COVERED, WITHOUT DELIVERY SY
MATERIAL FOR VOCAL CORD MEDIALIZATION, SYNTHETIC (
VENA CAVA FILTER
DIALYSIS ACCESS SYSTEM (IMPLANTABLE)
CARDIOVERTER-DEFIBRILLATOR, OTHER THAN SINGLE OR D
ADAPTOR/EXTENSION, PACING LEAD OR NEUROSTIMULATOR
EMBOLIZATION PROTECTIVE SYSTEM
CATHETER, TRANSLUMINAL ANGIOPLASTY, LASER
CATH EXTRAVASCULAR TISSUE ABLAT MODAL INSERTABLE
CATHETER, GUIDING (MAY INCLUDE INFUSION/PERFUSION
CATHETER, ABLATION, NON-CARDIAC, ENDOVASCULAR (IMP
INFUSION PUMP, NON-PROGRAMMABLE, PERMANENT (IMPLAN
INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPH
INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPH
INTRODUCER/SHEATH, OTHE THAN GUIDING, INTRACARDIAC
LEAD, CARDIOVERTER-DEFIBRILLATOR, ENDOCARDIAL DUAL
LEAD, CARDIOVERTER-DEFIBRILLATOR, OTHER THAN ENDOC
LEAD, NEUROSTIMULATOR TEST KIT (IMPLANTABLE)
LEAD, PACEMAKER, OTHER THAN TRANSVENOUS VDD SINGLE
LEAD, PACEMAKER/CARDIOVERTER-DEFIBRILLATOR COMBINA
LEAD, LEFT VENTRICULAR CORONARY VENOUS SYSTEM
LUNG BIOPSY PLUG WITH DELIVERY SYSTEM
PROBE, PERCUTANEOUS LUMBAR DISCECTOMY
SEALANT, PULMONARY, LIQUID
BRACHYTHERAPY SOURCE, YTTRIUM-90, PER SOURCE
STENT, NON-CORONARY, TEMPORARY, WITHOUT DELIVERY S
PROBE/NEEDLE CRYOABLATION
PACEMAKER, DUAL CHAMBER, NON RATE-RESPONSIVE (IMPL
PACEMAKER, SINGLE CHAMBER, NON RATE-RESPONSIVE (IM
PACEMAKER, OTHER THAN SINGLE OR DUAL CHAMBER (IMPL
PROSTHESIS, PENILE, NON-INFLATABLE
CATHETER, TRANSLUMINAL ANGIOPLASTY, DRUG-COATED, NON-LASER
IMPL WIRELESS PULM ARTERY PRESS SENSOR DEL CATH
STENT, NON-CORONARY, TEMPORARY, WITH DELIVERY SYST
INFUSION PUMP, NON-PROGRAMMABLE, TEMPORARY (IMPLAN
CATHETER, SUPRAPUBIC/CYSTOSCOPIC
CATHETER, OCCLUSION
INTRDUCR/SHTH OTH THAN GUID OTH THAN IC EEG LASR
CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION,
REPAIR DEVICE, URINARY, INCONTINENCE, WITHOUT SLIN
BRACHYTHERAPY SOURCE, NON-STRANDED, IODINE-125,
BRACHYTHERAPY SRC CESIUM-131 CHLORID SOL PER MCI
BRACHYTHERAPY PLANAR SOURCE, PALLADIUM-103, PER SQUARE MILLIMETER
APPL SKN GRFT TRUNK ARM LEG 100 CM; 1ST 25 CM/<
APPL SG TRNK ARMS LEGS AREA 100 CM; EA ADD 25 CM
APPL SG TRUNK ARM LEG AREA >/=100 CM;1ST 100 CM
APPL SG TRNK ARM LEG AREA>/=100 CM;EA ADD 100 CM
APPL SG F-S-N-H-F-G-M-D A TO 100 CM; 1ST 25 CM/<
APPL SG F-S-N-H-F-G-M-D A TO 100 CM;EA ADD 25 CM
APP SG F/N/HF/G A >/=100 CM;1ST 100 CM/1% A CHLD
APP SG F/N/HF/G A >/=100 CM;EA ADD 100 CM/1% CHL
MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, ABDO
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, A
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FO
MAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST;
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAS
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOW
MAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST;
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAS
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOW
MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, CHES
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, C
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FO
MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, LOWE
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, L
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FO
MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, PELV
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, P
MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FO
TTE W OR W/O CONT CONG CARDIAC ANOMALIES; COMPLETE
TTE W OR W/O CONT CONG CARDIAC ANOM; F-UP/LIMIT
TTE REAL TIME IMAGE DOC 2D W/WO M-MODE; COMPLETE
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2007
1/1/2016
10/1/2011
10/1/2011
10/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
4/1/2013
1/1/2004
1/1/2004
1/1/2008
7/1/2014
1/1/2016
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2008
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
C8924
C8925
C8926
C8927
C8928
C8929
C8930
C8931
C8932
C8933
C8934
C8935
C8936
C8957
C9025
C9026
C9027
C9113
C9121
C9132
C9136
C9248
C9250
C9254
C9257
C9273
C9278
C9290
C9293
C9349
C9352
C9353
C9354
C9356
C9358
C9359
C9360
C9361
C9362
C9363
C9364
C9399
C9442
C9443
C9444
C9446
C9447
C9458
C9459
C9460
C9497
C9600
C9601
C9602
C9603
C9604
C9605
C9606
C9607
C9608
C9716
C9726
C9727
C9728
C9737
C9739
C9740
C9741
C9742
C9743
C9800
C9898
C9899
D0120
D0140
D0145
D0150
D0160
D0170
D0171
D0180
D0190
D0191
D0210
D0220
D0230
D0240
D0250
D0260
D0270
D0272
TTE REAL TIME IMAGE DOC 2D; FOLLOW-UP/LIMITED
TEE REAL TIME IMAGE DOC 2D; PROBE PLCMT ACQ I&R
TEE CONG CARDIAC ANOMALIES; PROBE PLCMT ACQ I&R
TEE MONITORING ASSESS CARDIAC PUMPIMG FUNCTION
TTE DURING REST AND CV STRESS TEST WITH I&R
TTE CMPL SPEC DOPPLER & COLOR FLOW DOPPLER ECHO
TTE CMPL DUR REST & CVST W/I&R W/PHYS SUP
MR ANGIOGRAPHY W/CONTRAST SPINAL CANAL CONTENTS
MR ANGIOGRAPHY W/O CONTRST SPINAL CANAL CONTENTS
MR ANGIO NO CONTRST FLW W/CONTRST SP CANAL CNTN
MR ANGIOGRAPHY WITH CONTRAST UPPER EXTREMITY
MR ANGIOGRAPHY WITHOUT CONTRAST UPPER EXTREMITY
MR ANGIO W/O CONTRST FOLLOWED W/CONTRST UP EXT
IV INFUSION FOR THERAPY, PROLONGED, REQ PUMP
INJECTION, RAMUCIRUMAB
INJECTION, VEDOLIZUMAB
INJECTION PEMBROLIZUMAB 1 MG
INJECTION, PANTOPRAZOLE SODIUM, PER VIAL
INJECTION, ARGATROBAN, PER 5 MG
PROTHROMBIN CMPLX CONC KCENTRA I.U. FCT IX ACTV
INJECTION FACTOR VIII FC FUSION PROTEIN PER I.U.
INJECTION CLEVIDIPINE BUTYRATE 1 MG
HUMAN PLASMA FIBRIN SEALANT, VAPOR-HEATED, SOLVENT
INJECTION LACOSAMIDE 1 MG
INJECTION BEVACIZUMAB 0.25 MG
SIPULEUCEL-T INCLUDING LEUKAPHERESIS PER INFUS
NJECTION INCOBOTULINUMTOXINA 1 UNIT
INJECTION, BUPIVACAINE LIPOSOME, 1MG
INJECTION GLUCARPIDASE 10 UNITS
FORTADERM & FORTADERM ANTIMICROBL TYP PER SQ CM
MICROPOROUS COLLAGEN IMPLANTABLE TUBE PER CM LEN
MICROPOROUS COLLAGEN IMPLANTABLE SLIT TUBE CM
ACELLULAR PERICARDIAL TISSUE MATRIX OF NON-HUMAN ORIGIN (VERITAS), PER SQUARE CE
TENDON POROUS MATRIX COLLAGEN & GAG PER SQ CM
DERMAL SUBSTITUTE, NATIVE, NONDENATURED COLLAGEN,
POROUS PURIFIED COLL MATRIX B VOID FILLR -0.5 CC
DERMAL SUBSTITUTE, NATIVE, NON DENATURED COLLAGEN,
COLLAGEN MATRIX NERVE WRAP (NEUROMEND COLLAGEN NER
POROUS PURIFIED COLLAGEN MATRIX BONE VOID FILLER (
SKIN SUBSTITUE (INTEGRA MESHED BILAYER WOULD MATRI
PORCINE IMPLANT (PERMACOL), PER SQUARE CM
UNCLASSIFIED DRUGS OR BIOLOGICALS
INJECTION BELINOSTAT 10 MG
INJECTION DALBAVANCIN 10 MG
INJECTION ORITAVANCIN 10 MG
INJECTION TEDIZOLID PHOSPHATE 1 MG
INJECTION PHENYLEPHRINE AND KETOROLAC 4 ML VIAL
FLORBETABEN F18, DIAGNOSTIC, PER STUDY DOSE, UP TO 8.1 MILLICURIES
FLUTEMETAMOL F18, DIAGNOSTIC, PER STUDY DOSE, UP TO 5 MILLICURIES
INJECTION, CANGRELOR, 1 MG
LOXAPINE INHALATION POWDER 10 MG
PC TRNSCTH PLCMT RX ELUT IC STENTS; 1 MAJ CA/BR
PC TRNSCTH PLCMT RX-ELUT IC STNT;EA ADD BR MCA
PC TL COR ATHERECT W/RX ELUT IC STENT; 1 MCA/BR
PERQ TL COR ATHERECT; EA ADD BR MAJ CORONARY ART
PC TL REV OF/THRU CABG COMB DE IC STNT; 1 VES
PC TL REV OF/THRU CABG; EA ADD BR SUBTEND BP GFT
PERQ TL REV AC TOTAL/SUBTOTAL OCCLUSION 1 VES
PC TL REV CHRN TOT OCCL CA CA BR/CABG; 1 VES
PC TL REV CHRN TOT OCCL; EA ADD CA CA BR/BP GFT
CREATIONS OF THERMAL ANAL LESIONS BY RADIOFREQUENC
PLCMT & REMV AA INTO BRST IORT ADD-ON BRST PROC
INSERTION OF IMPLANTS INTO THE SOFT PALATE; MINIMU
PLCMT INTERSTITIAL DEV NOT ABD PELV PROS RP THOR
LAPAROSCOPY SURG ESOPHAGEAL SPHINCTER AUG W/DEVC
CYSTURETHRSCPY INSRT TRANSPROSTAT IMPL; 1-3 IMPL
CYSTURETHRSCPY INSRT TRANSPROSTAT IMPL; 4/> IMPL
RHC W/IMPLANTATION WIRELESS PRESS SENS PULM ART
LARYNGSCOP FLX FIBROPT INJ VOCAL CORD TX INCL DX
INJECTION/IMPLANTATION OF BULKING OR SPACER MATERIAL (ANY TYPE) WITH OR WITHOUT
DERM INJ FACL LDS PRVS RADIESSE/SCULPTRA FILLER
RADIOLABELED PROD PROV DURING A HOSPITAL IP STAY
IMPL PROS DEVC PAYBLE IP WHO DO NOT HAVE IP COV
PERIODIC ORAL EVALUATION
LIMITED ORAL EVALUATION - PROBLEM FOCUSED
Oral evaluation, pt < 3yrs
COMPREHENSIVE ORAL EVALUATION-NEW OR ESTABLISHED P
DETAILED AND EXTENSIVE ORAL EVALUATION - PROBLEM F
RE-EVALUATION-LIMITED, PROBLEM FOCUSED (ESTABLISHE
RE-EVALUATION - POST-OPERATIVE OFFICE VISIT
COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTA
SCREENING OF A PATIENT
ASSESSMENT OF A PATIENT
INTRAORAL-COMPLETE SERIES (INCLUDING BITEWINGS)
INTRAORAL-PERIAPICAL-FIRST FILM
INTRAORAL-PERIAPICAL-EACH ADDITIONAL FILM
INTRAORAL-0CCLUSAL FILM
EXTRAORAL-FIRST FILM
EXTRAORAL-EACH ADDITIONAL FILM
BITEWING-SINGLE FILM
BITEWINGS-TWO FILMS
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2008
1/1/2009
1/1/2009
6/3/2010
6/3/2010
6/3/2010
6/3/2010
6/3/2010
6/3/2010
1/1/2006
10/1/2014
10/1/2014
1/1/2015
1/1/2004
1/1/2004
10/1/2013
1/1/2015
1/1/2009
7/1/2009
1/1/2010
1/1/2010
10/1/2010
1/1/2011
4/1/2012
10/1/2012
1/1/2015
1/1/2008
1/1/2008
1/1/2008
7/1/2008
7/1/2009
1/1/2009
7/1/2009
7/1/2009
7/1/2009
7/1/2009
7/1/2009
1/1/2004
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2016
1/1/2016
1/1/2016
1/1/2014
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2006
1/1/2007
1/1/2010
1/1/2014
7/1/2014
7/1/2014
10/1/2014
1/1/2015
1/1/2016
3/23/2010
1/1/2009
1/1/2009
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2015
1/1/2004
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
D0273
D0274
D0277
D0290
D0310
D0320
D0321
D0322
D0330
D0340
D0350
D0351
D0363
D0364
D0365
D0366
D0367
D0368
D0369
D0370
D0371
D0380
D0381
D0382
D0383
D0384
D0385
D0386
D0391
D0393
D0394
D0395
D0415
D0416
D0417
D0418
D0421
D0425
D0431
D0460
D0470
D0472
D0473
D0474
D0475
D0476
D0477
D0478
D0479
D0480
D0481
D0482
D0483
D0484
D0485
D0486
D0502
D0601
D0602
D0603
D0999
D1110
D1120
D1206
D1208
D1310
D1320
D1330
D1351
D1352
D1353
D1510
D1515
D1520
D1525
D1550
D1555
D1999
D2140
D2150
D2160
D2161
D2330
D2331
D2332
D2335
D2390
D2391
D2392
D2393
D2394
Bitewings - three films
BITEWINGS-FOUR FILMS
VERTICAL BITEWINGS - 7 TO 8 FILMS
POSTERIOR-ANTERIOR OR LATERAL SKULL AND FACIAL BON
SIALOGRAPHY
TEMPOROMANDIBULAR JOINT ARTHROGRAM, INCLUDING INJE
OTHER TEMPOROMANDIBULAR JOINT FILMS, BY REPORT
TOMOGRAPHIC SURVEY
PANORAMIC FILM
CEPHALOMETRIC FILM
ORAL/FACIAL PHOTO IMAGE OBTAIN INTRA/EXTRAORLLY
3D PHOTOGRAPHIC IMAGE
Cone beam, three dimensional
CONE BEAM CT CAP&INTEPR LTD FD VIEW-<1 WHOLE JAW
CONE BEAM CT CAP&INT FD VW 1 FULL DENT ARCH-MAND
CONE BM CT CAP&INT FD VIEW 1 FULL DENT ARCH-MAX
CONE BEAM CT CAPTURE & INTERP FD VIEW BOTH JAWS
CONE BEAM CT CAP&INTEPR TMJ SERIES 2/> EXPOSURES
MAXILLOFACIAL MRI CAPTURE AND INTERPRETATION
MAXILLOFACIAL ULTRASOUND CAPTURE&INTERPRETATION
SIALOENDOSCOPY CAPTURE AND INTERPRETATION
CONE BEAM CT IMAG CAP W/LTD FD VIEW-<1 WHOLE JAW
CONE BM CT IMAG CAP FD VW 1 FULL DENT ARCH-MAND
CONE BEAM CT IMAG CAP FD VW 1 FULL DENT ARCH-MAX
CONE BEAM CT IMAGE CAPTURE FIELD VIEW BOTH JAWS
CONE BEAM CT IMAG CAP TMJ SERIES 2/> EXPOSURES
MAXILLOFACIAL MRI IMAGE CAPTURE
MAXILLOFACIAL ULTRASOUND IMAGE CAPTURE
INTEPR DX IMAG PRACTITNER NOT ASSOC CAP IMAG RPT
TREATMENT SIMULATION USING 3D IMAGE VOLUME
DIGTL SUBTRACTION 2/> IMAGES/IMAG VOL SAME MODAL
FUSION 2/MORE 3D IMAGES VOLUME 1/MORE MODALITIES
COLLECTION OF MICROORGANISMS FOR CULTURE AND SENSI
VIRAL CULTURE
CLCT & PREP SALIVA SAMPLE FOR LAB DX TESTING
ANALYSIS OF SALIVA SAMPLE
GENETIC TEST FOR SUSCEPTIBILITY TO ORAL DISEASES
CARIES SUSCEPTIBILITY TESTS
ADJUNCTIVE PRE-DIAGNOSTIC TEST THAT AIDS IN DETECT
PULP VITALITY TESTS
DIAGNOSTIC CASTS
ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATIO
ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINA
ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINA
DECALCIFICATION PROCEDURE
SPECIAL STAINS FOR MICROORGANISMS
SPECIAL STAINS, NOT FOR MICROORGANISMS
IMMUNOHISTOCHEMICAL STAINS
TISSUE IN-SITU HYBRIDIZATION, INCLUDING INTERPRETA
PROCESSING AND INTERPRETATION OF EXFOLIATIVE CYTOL
ELECTRON MICROSCOPY - DIAGNOSTIC
DIRECT IMMUNOFLUORESCENCE
INDIRECT IMMUNOFLUORESCENCE
CONSULTATION ON SLIDES PREPARED ELSEWHERE
CONSULTATION, INCLUDING PREPARATION OF SLIDES FROM
ACCESSION TRANSEPITHELIAL CYTOLOG SAMPL MIC EXAM
OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT
CARIES RISK ASSESSMENT & DOC FINDING LOW RISK
CARIES RISK ASSESSMENT & DOC FINDING MOD RISK
CARIES RISK ASSESSMENT & DOC FINDING HIGH RISK
UNSPECIFIED DIAGNOSTIC PROCEDURE, BY REPORT
PROPHYLAXIS-ADULT
PROPHYLAXIS; CHILD
Topical fluoride varnish
TOPICAL APPLICATION OF FLUORIDE
NUTRITIONAL COUNSELING FOR THE CONTROL OF DENTAL D
TOBACCO COUNSELING FOR THE CONTROL AND PREVENTION
ORAL HYGIENE INSTRUCTION
SEALANT - PER TOOTH
PREV RSN REST MOD HIGH CARIES RISK PT-PERM TOOTH
SEALANT REPAIR - PER TOOTH
SPACE MAINTAINER; FIXED-UNILATERAL
SPACE MAINTAINER; FIXED BILATERAL
SPACE MAINTAINER-REMOVABLE UNILATERAL
SPACE MAINTAINER-REMOVABLE BILATERAL
RECEMENTATION OF SPACE MAINTAINER
Remove fix space maintainer
UNSPECIFIED PREVENTIVE PROCEDURE BY REPORT
AMALGAM; ONE SURFACE, PRIMARY OR PERMANENT
AMALGAM; TWO SURFACES, PRIMARY OR PERMANENT
AMALGAM; THREE SURFACES, PRIMARY OR PERMANENT
AMALGAM; FOUR OR MORE SURFACES, PRIMARY OR PERMANE
RESIN-BASED COMPOSITE ONE SURFACE ANTERIOR
RESIN-BASED COMPOSITE, TWO SURFACES, ANTERIOR
RESIN-BASED COMPOSITE THREE SURFACES ANTERIOR
RESIN-BASED COMPOSITE 4/> SURFACES INCISAL ANGLE
RESIN-BASED COMPOSITE CROWN, ANTERIOR
RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR
RESIN-BASED COMPOSITE - TWO SURFACES POSTERIOR
RESIN-BASED COMPOSITE - 3 SURFACES POSTERIOR
RESIN-BASED COMPOSITE-4 OR MORE SURFACES, POSTERIO
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2007
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2011
1/1/2015
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2014
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
D2410
D2420
D2430
D2510
D2520
D2530
D2542
D2543
D2544
D2610
D2620
D2630
D2642
D2643
D2644
D2650
D2651
D2652
D2662
D2663
D2664
D2710
D2712
D2720
D2721
D2722
D2740
D2750
D2751
D2752
D2780
D2781
D2782
D2783
D2790
D2791
D2792
D2794
D2799
D2910
D2915
D2920
D2921
D2929
D2930
D2931
D2932
D2933
D2934
D2940
D2941
D2949
D2950
D2951
D2952
D2953
D2954
D2955
D2957
D2960
D2961
D2962
D2970
D2971
D2975
D2980
D2981
D2982
D2983
D2990
D2999
D3110
D3120
D3220
D3221
D3222
D3230
D3240
D3310
D3320
D3330
D3331
D3332
D3333
D3346
D3347
D3348
D3351
D3352
D3353
D3354
GOLD FOIL-ONE SURFACE
GOLD FOIL-TWO SURFACES
GOLD FOIL-THREE SURFACES
INLAY-METALLIC-ONE SURFACE
INLAY-METALLIC-TWO SURFACES
INLAY-METALLIC-THREE OR MORE SURFACES
ONLAY-METALLIC-TWO SURFACES
ONLAY - METALLIC - THREE SURFACES
ONLAY - METALLIC - FOUR OR MORE SURFACES
INLAY-PORCELAIN/CERAMIC-ONE SURFACE
INLAY-PORCELAIN/CERAMIC-TWO SURFACES
INLAY-PORCELAIN/CERAMIC-THREE OR MORE SURFACES
ONLAY - PORCELAIN/CERAMIC - TWO SURFACES
ONLAY - PORCELAIN/CERAMIC - THREE SURFACES
ONLAY - PORCELAIN/CERAMIC - FOUR OR MORE SURFACES
INLAY - RESIN-BASED COMPOSITE - ONE SURFACE
INLAY - RESIN-BASED COMPOSITE - TWO SURFACES
INLAY - RESIN-BASED COMPOSITE - THREE OR MORE SURF
ONLAY - RESIN-BASED COMPOSITE - TWO SURFACES
ONLAY - RESIN-BASED COMPOSITE - THREE SURFACES
ONLAY - - RESIN-BASED COMPOSITE - FOUR OR MORE SUR
CROWN - RESIN-BASED COMPOSITE (INDIRECT)
CROWN - 3/4 RESIN-BASED COMPOSITE (INDIRECT)
CROWN-RESIN WITH HIGH NOBLE METAL
CROWN-RESIN WITH PREDOMINANTLY BASE METAL
CROWN-RESIN WITH NOBLE METAL
CROWN-PORCELAIN/CERAMIC SUBSTRATE
CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL
CROWN-PROCELAIN FUSED TO PREDOMINANTLY BASE METAL
CROWN-PORCELAIN FUSED TO NOBLE METAL
CROWN - 3/4 CAST HIGH NOBLE METAL
CROWN - 3/4 CAST PREDOMINANTLY BASE METAL
CROWN - 3/4 CAST NOBLE METAL
CROWN - 3/4 PORCELAIN/CERAMIC
CROWN-FULL CAST HIGH NOBLE METAL
CROWN-FULL CAST PREDOMINANTLY BASE METAL
CROWN-FULL CAST NOBLE METAL
CROWN-TITANIUM
PROVISIONAL CROWN
RECEMENT INLAY, ONLAY OR PARTIAL COVERAGE RESTORAT
RECEMENT CAST OR PREFABRICATED POST AND CORE
RECEMENT CROWN
REATTACHMENT TOOTH FRAGMENT INCISAL EDGE/CUSP
PREFAB PORCELAIN/CERAMIC CROWN - PRIMARY TOOTH
PREFABRICATED STAINLESS STEEL CROWN; PRIMARY TOOTH
PREFABRICATED STAINLESS STEEL CROWN; PERMANENT TOO
PREFABRICATED RESIN CROWN
PREFABRICATED STAINLESS STEEL CROWN W/ RESIN WINDO
PREFABRICATED ESTHETIC COATED STAINLESS STEEL CROW
PROTECTIVE RESTORATION
INTERIM THERAPEUTIC RESTORATION-PRIMARY DENTITN
RESTORATIVE FOUNDATION AN INDIRECT RESTORATION
CORE BUILDUP INCLUDING ANY PINS WHEN REQUIRED
PIN RETENTION-PER TOOTH, IN ADDITION TO RESTORATIO
CAST POST AND CORE IN ADDITION TO CROWN
EACH ADDITIONAL CAST POST - SAME TOOTH
PREFABRICATED POST AND CORE IN ADDITION TO CROWN
POST REMOVAL (NOT IN CONJUCTION WITH ENDODONTIC TH
EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH
LABIAL VENEER RESIN LAMINATE - CHAIRSIDE
LABIAL VENEER (RESIN LAMINATE)-LABORATORY
LABIAL VENEER (PORCELAIN LAMINATE)-LABORATORY
TEMPORARY CROWN FRACTURED TOOTH
ADDITIONAL PROCEDURES TO CONSTRUCT NEW CROWN UNDER
COPING
CROWN REPAIR, BY REPORT
INLAY REPAIR NECESSITATED RESTORATIVE MATL FAIL
ONLAY REPAIR NECESSITATED RESTORATIVE MATL FAIL
VENEER REPAIR NECESSITATED RESTORATIVE MATL FAIL
RESIN INFILTRATION INCIPIENT SMOOTH SURFACE LES
UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT
PULP CAP-DIRECT (EXCLUDING FINAL RESTORATION)
PULP CAP-INDIRECT (EXCLUDING FINAL RESTORATION)
THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION
PULPAL DEBRIDEMENT, PRIMARY AND PERMANENT TEETH
PART PULPOTOMY FOR APEXOGENEIS PERM TOOTH
PULPAL THERAPY (RESORBABLE FILLING)-ANTERIOR, PRIM
PULPAL THERAPY (RESORBABLE FILLING)-POSTERIOR, PRI
ENDODONTIC THERAPY ANTERIOR (EXCLUDING FINAL RESTO
ENDODONTIC THERAPY BICUSPID (EXCLUDING FINAL RESTO
ENDODONTIC THPY(EXCLUDING FINAL RESTORATION) MOLAR
TREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL
INCOMPLETE ENDODONTIC THERAPY; INOPERABLE, UNRESTO
INTERNAL ROOT REPAIR OF PERFORATION DEFECTS
RETREATMENT OF PREVIOUS ROOT CANAL THERAPY; ANTERI
RETREATMENT OF PREVIOUS ROOT CANAL THERAPY; BICUSP
RETREATMENT OF PREVIOUS ROOT CANAL THERAPY; MOLAR
APEXIFICATION/RECALCIFICATION INITIAL VISIT
APEXIFICATION/RECALCIFICATN INTERIM MED REPLACE
APEXIFICATION/RECALCIFICATION-FINAL VISIT (INCLUDE
PUPAL REGENERATION; NOT INCL FINAL RESTORATION
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2014
1/1/2013
1/1/2007
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2014
1/1/2014
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2011
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
D3355
D3356
D3357
D3410
D3421
D3425
D3426
D3427
D3428
D3429
D3430
D3431
D3432
D3450
D3460
D3470
D3910
D3920
D3950
D3999
D4210
D4211
D4212
D4230
D4231
D4240
D4241
D4245
D4249
D4260
D4261
D4263
D4264
D4265
D4266
D4267
D4268
D4270
D4273
D4274
D4275
D4276
D4277
D4278
D4283
D4285
D4320
D4321
D4341
D4342
D4355
D4381
D4910
D4920
D4921
D4999
D5110
D5120
D5130
D5140
D5211
D5212
D5213
D5214
D5225
D5226
D5281
D5410
D5411
D5421
D5422
D5510
D5520
D5610
D5620
D5630
D5640
D5650
D5660
D5670
D5671
D5710
D5711
D5720
D5721
D5730
D5731
D5740
D5741
D5750
D5751
PULPAL REGENERATION - INITIAL VISIT
PULPAL REGENERATION - INTERIM MEDICATION REPLACE
PULPAL REGENERATION - COMPLETION OF TREATMENT
APICOECTOMY - ANTERIOR
APICOECTOMY - BICUSPID FIRST ROOT
APICOECTOMY - MOLAR FIRST ROOT
APICOECTOMY EACH ADDITIONAL ROOT
PERIRADICULAR SURGERY WITHOUT APICOECTOMY
BONE GRAFT W/PERIRADICULAR SURG PER TOOTH 1 SITE
BONE GRAFT PERIRADICULR SURG EA ADD CONTIG TOOTH
RETROGRADE FILLING - PER ROOT
BIOL MATL SOFT OSS TISS REGEN PERIRADICULAR SURG
GUIDED TISS REGEN RESORB BARR PERIRADICULAR SURG
ROOT AMPUTATION-PER ROOT
ENDODONTIC ENDOSSEOUS IMPLANT
INTENTIONAL REIMPLANTATION W/NECESSARY SPLINTING
SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUB
HEMISECTION (INCLUDING ANY ROOT REMOVAL), NOT INCL
Canal preparation & fitting of performed dowel or
UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT
Gingivectomy or gingivoplasty 4 or more continuous
GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE CONTI
GING/GINGIVOPLASTY ALLW ACSS RESTORATV PRO-TOOTH
Ana crown exp 4 or> per quad
Ana crown exp 1-3 per quad
GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING APICALLY POSITIONED FLAP
CLINICAL CROWN LENGTHENING-HARD TISSUE
OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE)
OSSEOUS SURGERY(INCLUDING FLAP ENTRY & CLOSURE)
BONE REPLACEMENT GRAFT - FIRST SITE IN QUADRANT
BONE REPLACEMENT GRAFT - EACH ADDITIONAL SITE IN Q
BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISS
GUIDED TISSUE REGENERATION - RESORBABLE BARRIER, P
GUIDED TISSUE REGENERATION - NONRESORBABLE BARRIER
SURGICAL REVISION PROCEDURE, PER TOOTH
PEDICLE SOFT TISSUE GRAFT PROCEDURE
SUBEPITHELIAL CONNECTIVE TISSUE GRAFT PROCEDURES,
DISTAL OR PROXIMAL WEDGE PROCEDURE (WHEN NOT PERFO
SOFT TISSUE ALLOGRAFT
COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAF
FREE SFT TSS GFT PROC 1ST T/EDNTULS T PSTN GFT
FREE SFT TSS GFT EA ADD CNTIG T/EDNT T SAME SITE
AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE
NON-AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE
PROVISIONAL SPLINTING-INTRACORONAL
PROVISIONAL SPLINTING-EXTRACORONAL
Perio Scaling/Root Planing 4 or more teeth per qua
PERIODONTAL SCALING AND ROOT PLANING - 1 TO 3 TEET
FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVA
LOCALIZED DELIVERY OF ANTIMICROBIAL AGENTS VIA A C
PERIODONTAL MAINTENANCE
UNSCHEDULED DRESSING CHANGE NOT TX DENTIST STAFF
GINGIVAL IRRIGATION - PER QUADRANT
UNSPECIFIED PERIODONTAL PROCEDURE, BY REPORT
COMPLETE DENTURE - MAXILLARY
COMPLETE DENTURE - MANDIBULAR
IMMEDIATE DENTURE - MAXILLARY
IMMEDIATE DENTURE - MANDIBULAR
MAXILLARY PARTIAL DENTURE - RESIN BASE
MANDIBULAR PARTIAL DENTURE - RESIN BASE
MAXILLARY PARTIAL DENTURE - CAST METAL FRAMEWORK W
MANDIBULAR PARTIAL DENTURE - CAST METAL FRAMEWORK
MAXILLARY PARTIAL DENTURE - FLEXIBLE BASE (INCLUDI
MANDIBULAR PARTIAL DENTURE - FLEXIBLE BASE (INCLUD
REMOVABLE UNILATERAL PARTIAL DENTURE-ONE PIECE CAS
ADJUST COMPLETE DENTURE - MAXILLARY
ADJUST COMPLETE DENTURE - MANDIBULAR
ADJUST PARTIAL DENTURE - MAXILLARY
ADJUST PARTIAL DENTURE - MANDIBULAR
REPAIR BROKEN COMPLETE DENTURE BASE
REPLACE MISSING OR BROKEN TEETH-COMPLETE DENTURE (
REPAIR RESIN DENTURE BASE
REPAIR CAST FRAMEWORK
REPAIR OR REPLACE BROKEN CLASP
REPLACE BROKEN TEETH-PER TOOTH
ADD TOOTH TO EXISTING PARTIAL DENTURE
ADD CLASP TO EXISTING PARTIAL DENTURE
REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEW
REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEW
REBASE COMPLETE MAXILLARY DENTURE
REBASE COMPLETE MANDIBULAR DENTURE
REBASE MAXILLARY PARTIAL DENTURE
REBASE MANDIBULAR PARTIAL DENTURE
RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE)
RELINE COMPLETE MANDIBULAR DENTURE CHAIRSIDE
RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE)
RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE)
RELINE COMPLETE MAXILLARY DENTURE (LABORATORY)
RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY)
1/1/2014
1/1/2014
1/1/2014
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2014
1/1/2014
1/1/2014
1/1/2007
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2013
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
D5760
D5761
D5810
D5811
D5820
D5821
D5850
D5851
D5860
D5861
D5862
D5863
D5864
D5865
D5866
D5867
D5875
D5899
D5911
D5912
D5913
D5914
D5915
D5916
D5919
D5922
D5923
D5924
D5925
D5926
D5927
D5928
D5929
D5931
D5932
D5933
D5934
D5935
D5936
D5937
D5951
D5952
D5953
D5954
D5955
D5958
D5959
D5960
D5982
D5983
D5984
D5985
D5986
D5987
D5988
D5991
D5992
D5993
D5994
D5999
D6010
D6011
D6012
D6013
D6040
D6050
D6051
D6052
D6055
D6056
D6057
D6058
D6059
D6060
D6061
D6062
D6063
D6064
D6065
D6066
D6067
D6068
D6069
D6070
D6071
D6072
D6073
D6074
D6075
D6076
D6077
RELINE MAXILLARY PARTIAL DENTURE (LABORATORY)
RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY)
INTERIM COMPLETE DENTURE (MAXILLARY)
INTERIM COMPLETE DENTURE (MANDIBULAR)
INTERIM PARTIAL DENTURE (MAXILLARY)
INTERIM PARTIAL DENTURE (MANDIBULAR)
TISSUE CONDITIONING, MAXILLARY
TISSUE CONDITIONING, MANDIBULAR
OVERDENTURE-COMPLETE, BY REPORT
OVERDENTURE-PARTIAL, BY REPORT
PRECISION ATTACHMENT, BY REPORT
OVERDENTURE - COMPLETE MAXILLARY
OVERDENTURE - PARTIAL MAXILLARY
OVERDENTURE - COMPLETE MANDIBULAR
OVERDENTURE - PARTIAL MANDIBULAR
REPLACEMENT OF REPLACEABLE PART OF SEMI-PRECISION
MODIFICATION OF REMOVABLE PROSTHESIS FOLLOWING IMP
UNSPECIFIED REMOVABLE PROSTHODONTIC PROCEDURE, BY
FACIAL MOULAGE (SECTIONAL)
FACIAL MOULAGE (COMPLETE)
NASAL PROSTHESIS
AURICULAR PROSTHESIS
ORBITAL PROSTHESIS
OCULAR PROSTHESIS
FACIAL PROSTHESIS
NASAL SEPTAL PROSTHESIS
OCULAR PROSTHESIS, INTERIM
CRANIAL PROSTHESIS
FACIAL AUGMENTATION IMPLANT PROSTHESIS
NASAL PROSTHESIS, REPLACEMENT
AURICULAR PROSTHESIS, REPLACEMENT
ORBITAL PROSTHESIS, REPLACEMENT
FACIAL PROSTHESIS, REPLACEMENT
OBTURATOR PROSTHESIS, SURGICAL
OBTURATOR PROSTHESIS, DEFINITIVE
OBTURATOR PROSTHESIS, MODIFICATION
MANDIBULAR RESECTION PROSTHESIS WITH GUIDE FLANGE
MANDIBULAR RESECTION PROSTHESIS WITHOUT GUIDE FLAN
OBTURATOR/PROSTHESIS, INTERIM
TRISMUS APPLIANCE NOT FOR TMD TREATMENT
FEEDING AID
SPEECH AID PROSTHESIS, PEDIATRIC
SPEECH AID PROSTHESIS, ADULT
PALATAL AUGMENTATION PROSTHESIS
PALATAL LIFT PROSTHESIS, DEFINITIVE
PALATAL LIFT PROSTHESIS, INTERIM
PALATAL LIFT PROSTHESIS, MODIFICATION
SPEECH AID PROSTHESIS, MODIFICATION
SURGICAL STENT
RADIATION CARRIER
RADIATION SHIELD
RADIATION CONE LOCATOR
FLUORIDE GEL CARRIER
COMMISSURE SPLINT
SURGICAL SPLINT
VESICULOBULLOUS DISEASE MEDICAMENT CARRIER
ADJUST MAXILLOFACIAL PROSTH APPLIANCE BY REPORT
MAINT CLEAN MAXILLOFACIAL PROSTH OTH THN REQ ADJ
PERIODONTAL MED CARR PERIPH SEAL LAB PROCESSED
UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT
SURGICAL PLACEMENT OF IMPLANT BODY: ENDOSTEAL IMP
SECOND STAGE IMPLANT SURGERY
Endosteal implant
SURGICAL PLACEMENT OF MINI IMPLANT
SURGICAL PLACEMENT: EPOSTEAL IMPLANT
SURGICAL PLACEMENT: TRANSOSTEAL IMPLANT
INTERIM ABUTMENT
SEMI-PRECISION ATTACHMENT ABUTMENT
CONNECTING BAR IMPLANT OR ABUTMENT SUPPORTED
PREFABRICATED ABUTMENT - INCLUDES PLACEMENT
CUSTOM ABUTMENT - INCLUDES PLACEMENT
ABUTMENT SUPPORTED PORCELAIN/CERAMIC CROWN
ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN
ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN
ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN
ABUTMENT SUPPORTED CAST METAL CROWN (HIGH NOBLE ME
ABUTMENT SUPPORTED CAST METAL CROWN (PREDOMINANTLY
ABUTMENT SUPPORTED CAST METAL CROWN (NOBLE METAL)
IMPLANT SUPPORTED PORCELAIN/CERAMIC CROWN
IMPLANT SUPPORTED PORCELAIN FUSED TO METAL CROWN (
IMPLANT SUPPORTED METAL CROWN (TITANIUM, TITANIUM
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN/CERAMIC
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO
ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO
ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (H
ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (P
ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (N
IMPLANT SUPPORTED RETAINER FOR CERAMIC FPD
IMPLANT SUPPORTED RETAINER FOR PORCELAIN FUSED TO
IMPLANT SUPPORTED RETAINER FOR CAST METAL FPD (TIT
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2014
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2011
1/1/2011
1/1/2014
1/1/2004
1/1/2004
1/1/2014
1/1/2007
1/1/2014
1/1/2004
1/1/2004
1/1/2013
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
D6080
D6090
D6091
D6092
D6093
D6094
D6095
D6100
D6101
D6102
D6103
D6104
D6110
D6111
D6112
D6113
D6114
D6115
D6116
D6117
D6190
D6194
D6199
D6205
D6210
D6211
D6212
D6214
D6240
D6241
D6242
D6245
D6250
D6251
D6252
D6253
D6545
D6548
D6549
D6600
D6601
D6602
D6603
D6604
D6605
D6606
D6607
D6608
D6609
D6610
D6611
D6612
D6613
D6614
D6615
D6624
D6634
D6710
D6720
D6721
D6722
D6740
D6750
D6751
D6752
D6780
D6781
D6782
D6783
D6790
D6791
D6792
D6793
D6794
D6920
D6930
D6940
D6950
D6980
D6985
D6999
D7111
D7140
D7210
D7220
D7230
D7240
D7241
D7250
D7251
D7260
IMPL MAINT PROC REMV REINSRT CLEAN PROSTH & ABUT
REPAIR IMPLANTSUPPORTED PROSTHESIS BY REPORT
Repl semi/precision attach
Recement supp crown
Recement supp part denture
ABUTMENT SUPPORTED CROWN - (TITANIUM)
REPAIR IMPLANT ABUTMENT, BY REPORT
IMPLANT REMOVAL, BY REPORT
DEBR PERIIMPL DFCT CLN EXPSD IMPL FLP ENTRY CLO
DEBR&OSS CNTR PERIIMPL DFCT;SURF&FLAP ENTRY&CLOS
BN GFT PERIIMPL DFCT-NO FLP/BR MB/BIOL MATL
BONE GRAFT AT TIME OF IMPLANT PLACEMENT
IMPL/ABUT SUPP REMV DENTURE EDENTULOUS ARCH-MAX
IMPL/ABUT SUPP REMV DENTURE EDENTULOUS ARCH-MND
IMPL/ABUT SUPP REMV DENTURE PART EDENT ARCH-MAX
IMPL/ABUT SUPP REMV DENTURE PART EDENT ARCH-MAND
IMPL/ABUT SUPP FIXED DENTURE EDENTULOUS ARCH-MAX
IMPL/ABUT SUPP FIXD DENTURE EDENTULOUS ARCH-MAND
IMPL/ABUT SUPP FIXED DENTURE PART EDENT ARCH-MAX
IMPL/ABUT SUPP FIXD DENTURE PART EDENT ARCH-MAND
RADIOGRAPHIC/SURGICAL IMPLANT INDEX, BY REPORT
ABUTMENT SUPPORTED RETAINER CROWN FOR FPD - (TITAN
UNSPECIFIED IMPLANT PROCEDURE, BY REPORT
PONTIC - INDIRECT RESIN BASED COMPOSITE
PONTIC-CAST HIGH NOBLE METAL
PONTIC-CAST PREDOMINANTLY BASE METAL
PONTIC-CAST NOBLE METAL
PONTIC - TITANIUM
PONTIC-PORCELAIN FUSED TO HIGH NOBLE METAL
PONTIC-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL
PONTIC-PORCELAIN FUSED TO NOBLE METAL
PONTIC - PORCELAIN/CERAMIC
PONTIC-RESIN WITH HIGH NOBLE METAL
PONTIC-RESIN WITH PREDOMINANTLY BASE METAL
PONTIC-RESIN WITH NOBLE METAL
PROVISIONAL PONTIC
RETAINER-CAST METAL FOR RESIN BONDED FIXED PROSTHE
RETAINER - PORCELAIN/CERAMIC FOR RESIN BONDED FIXE
RESIN RETAINER-FOR RESIN BONDED FIXED PROSTHESIS
INLAY-PORCELAIN/CERAMIC, TWO SURFACES
INLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
INLAY - CAST HIGH NOBLE METAL, TWO SURFACES
INLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFA
INLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACE
INLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MO
INLAY - CAST NOBLE METAL, TWO SURFACES
INLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
ONLAY - PORCELAIN/CERAMIC, TWO SURFACES
ONLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES
ONLAY - CAST HIGH NOBLE METAL, TWO SURFACES
ONLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFA
ONLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACE
ONLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MO
ONLAY - CAST NOBLE METAL, TWO SURFACES
ONLAY - CAST NOBLE METAL, THREE OR MORE SURFACES
INLAY - TITANIUM
ONLAY - TITANIUM
CROWN - INDIRECT RESIN BASED COMPOSITE
CROWN-RESIN WITH HIGH NOBLE METAL
CROWN-RESIN WITH PREDOMINANTLY BASE METAL
CROWN-RESIN WITH NOBLE METAL
CROWN - PORCELAIN/CERAMIC
CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL
CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL
CROWN-PORCELAIN FUSED TO NOBLE METAL
CROWN-3/4 CAST HIGH NOBLE METAL
CROWN - 3/4 CAST PREDOMINANTLY BASED METAL
CROWN - 3/4 CAST NOBLE METAL
CROWN - 3/4 PORCELAIN/CERAMIC
CROWN-FULL CAST HIGH NOBLE METAL
CROWN-FULL CAST PREDOMINANTLY BASE METAL
CROWN-FULL CAST NOBLE METAL
PROVISIONAL RETAINER CROWN
CROWN - TITANIUM
CONNECTOR BAR
RECEMENT FIXED PARTIAL DENTURE
STRESS BREAKER
PRECISION ATTACHMENT
FIXED PARTIAL DENTURE REPAIR BY REPORT
PEDIATRIC PARTIAL DENTURE, FIXED
UNSPECIFIED FIXED PROSTHODONTIC PROCEDURE, BY REPO
EXTRACTION, CORONAL REMNANTS - DECIDUOUS TOOTH
EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATI
SURG REMOVAL ERUPTED TOOTH REMV BONE ELEV FLAP
REMOVAL OF IMPACTED TOOTH-SOFT TISSUE
REMOVAL OF IMPACTED TOOTH-PARTIALLY BONY
REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY
OF IMPACTED TOOTH; COMPLETELY BONY WITH UNUSUAL S
SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING
CORONECTOMY - INTENTIONAL PARTIAL TOOTH REMOVAL
OROANTRAL FISTULA CLOSURE
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2013
1/1/2013
1/1/2013
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2011
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
D7261
D7270
D7272
D7280
D7282
D7283
D7285
D7286
D7287
D7288
D7290
D7291
D7292
D7293
D7294
D7295
D7310
D7311
D7320
D7321
D7340
D7350
D7410
D7411
D7412
D7413
D7414
D7415
D7440
D7441
D7450
D7451
D7460
D7461
D7465
D7471
D7472
D7473
D7485
D7490
D7510
D7511
D7520
D7521
D7530
D7540
D7550
D7560
D7610
D7620
D7630
D7640
D7650
D7660
D7670
D7671
D7680
D7710
D7720
D7730
D7740
D7750
D7760
D7770
D7771
D7780
D7810
D7820
D7830
D7840
D7850
D7852
D7854
D7856
D7858
D7860
D7865
D7870
D7871
D7872
D7873
D7874
D7875
D7876
D7877
D7880
D7899
D7910
D7911
D7912
D7920
PRIMARY CLOSURE OF A SINUS PERFORATION
TOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCID
TOOTH TRANSPLANTATION (INCLUDES REIMPLANTATION FRO
SURGICAL ACCESS OF AN UNERUPTED TOOTH
MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO
PLACEMENT OF DEVICE TO FACILITATE ERUPTION OF IMPA
BIOPSY OF ORAL TISSUE; HARD (BONE, TOOTH)
BIOPSY OF ORAL TISSUE; SOFT
EXFOLIATIVE CYTOLOGICAL SAMPLE COLLECTION
BRUSH BIOPSY - TRANSEPITHELIAL SAMPLE COLLECTION
SURGICAL REPOSITIONING OF TEETH
TRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL FIBEROTOMY, B
Screw retained plate
Temp anchorage dev w flap
Temp anchorage dev w/o flap
HARVEST BONE FOR USE AUTOGENOUS GRAFTING PROC
ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - PE
ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - ON
ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS
ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS
VESTIBULOPLASTY-RIDGE EXTENSION (SECOND EPITHELIAL
VESTIBULOPLASTY-RIDGE EXTENSION (INCLUDING SOFT TI
EXCISION OF BENIGN LESION UP TO 1.25 CM
EXCISION OF BENIGN LESION GREATER THAN 1.25 CM
EXCISION OF BENIGN LESION, COMPLICATED
EXCISION OF MALIGNANT LESION UP TO 1.25 CM
EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM
EXCISION OF MALIGNANT LESION, COMPLICATED
EXCISION OF MALIGNANT TUMOR-LESION DIAMETER UP TO
EXCISION OF MALIGNANT TUMOR-LESION DIAMETER GREATE
REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION
REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION
REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LES
REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LES
DESTRUCTION OF LESION(S) BY PHYSICAL OR CHEMICAL M
REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE)
REMOVAL OF TORUS PALATINUS
REMOVAL OF TORUS MANDIBULARIS
SURGICAL REDUCTION OF OSSEOUS TUBEROSITY
RADICAL RESECTION OF MAXILLA OR MANDIBLE
INCISION AND DRAINAGE OF ABSCESS-INTRAORAL SOFT TI
INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT
INCISION AND DRAINAGE OF ABSCESS-EXTRAORAL SOFT TI
INCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT
REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBC
REMOVAL OF REACTION-PRODUCING FOREIGN BODIES-MUSCU
PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NO
MAXILLARY SINUSOTOMY FOR REMOVAL OF TOOTH FRAGMENT
MAXILLA-OPEN REDUCTION (TEETH IMMOBILIZED IF PRESE
MAXILLA-CLOSED REDUCTION (TEETH IMMOBILIZED IF PRE
MANDIBLE-OPEN REDUCTION (TEETH IMMOBILIZED IF PRES
MANDIBLE-CLOSED REDUCTION (TEETH IMMOBILIZED IF PR
MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION
MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION
ALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZA
ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATI
FACIAL BONES-COMPLICATED REDUCTION WITH FIXATION A
MAXILLA-OPEN REDUCTION
MAXILLA-CLOSED REDUCTION
MANDIBLE-OPEN REDUCTION
MANDIBLE-CLOSED REDUCTION
MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION
MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION
ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH
ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH
FACIAL BONES-COMPLICATED REDUCTION WITH FIXATION A
OPEN REDUCTION OF DISLOCATION
CLOSED REDUCTION OF DISLOCATION
MANIPULATION UNDER ANESTHESIA
CONDYLECTOMY
SURGICAL DISCECTOMY; WITH/WITHOUT IMPLANT
DISC REPAIR
SYNOVECTOMY
MYOTOMY
JOINT RECONSTRUCTION
ARTHROTOMY
ARTHROPLASTY
ARTHROCENTESIS
NON-ARTHROSCOPIC LYSIS AND LAVAGE
ARTHROSCOPY-DIAGNOSIS, WITH OR WITHOUT BIOPSY
ARTHROSCOPY-SURGICAL: LAVAGE AND LYSIS OF ADHESION
ARTHROSCOPY-SURGICAL: DISC REPOSITIONING AND STABI
ARTHROSCOPY-SURGICAL: SYNOVECTOMY
ARTHROSCOPY-SURGICAL: DISCECTOMY
ARTHROSCOPY-SURGICAL: DEBRIDEMENT
OCCLUSAL ORTHOTIC DEVICE BY REPORT
UNSPECIFIED TMD THERAPY, BY REPORT
SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM
COMPLICATED SUTURE-UP TO 5 CM
COMPLICATED SUTURE-GREATER THAN 5 CM
SKIN GRAFT (IDENTIFY DEFECT COVERED, LOCATION, AND
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2007
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
D7921
D7940
D7941
D7943
D7944
D7945
D7946
D7947
D7948
D7949
D7950
D7951
D7952
D7953
D7955
D7960
D7963
D7970
D7971
D7972
D7980
D7981
D7982
D7983
D7990
D7991
D7995
D7996
D7997
D7998
D7999
D8010
D8020
D8030
D8040
D8050
D8060
D8070
D8080
D8090
D8210
D8220
D8660
D8670
D8680
D8690
D8691
D8692
D8693
D8694
D8999
D9110
D9120
D9210
D9211
D9212
D9215
D9219
D9220
D9221
D9223
D9230
D9241
D9242
D9243
D9248
D9310
D9410
D9420
D9430
D9440
D9450
D9610
D9612
D9630
D9910
D9911
D9920
D9930
D9931
D9940
D9941
D9942
D9950
D9951
D9952
D9970
D9971
D9972
D9973
D9974
COLLECTION & APPLIC AUTO BLOOD CONCENTRATE PROD
OSTEOPLASTY-FOR ORTHOGNATHIC DEFORMITIES
OSTEOTOMY - MANDIBULAR RAMI
OSTEOTOMY - MANDIBULAR RAMI WITH BONE GRAFT; INCLU
OSTEOTOMY-SEGMENTED OR SUBAPICAL-PER SEXTANT OR QU
OSTEOTOMY-BODY OF MANDIBLE
LEFORT I (MAXILLA-TOTAL)
LEFORT I (MAXILLA-SEGMENTED)
LEFORT II OR LEFORT III (OSTEOPLASTY OF FACIAL BON
LEFORT II OR LEFORT III-WITH BONE GRAFT
OSSEOUS, OSTEOPERIOSTEAL, OR CARTILAGE GRAFT OF TH
Sinus aug w bone/bone sup
SINUS AUGMENTATION VIA A VERTICAL APPROACH
BONE REPLACEMENT GRAFT FOR RIDGE PRESERVATION - PE
REPAIR OF MAXILLOFACIAL SOFT AND/OR HARD TISSUE DE
FRENULECTOMY SEP PROC NOT INCIDENTL ANOTHER PROC
FRENULOPLASTY
EXCISION OF HYPERPLASTIC TISSUE-PER ARCH
EXCISION OF PERICORONAL GINGIVA
SURGICAL REDUCTION OF FIBROUS TUBEROSITY
SIALOLITHOTOMY
EXCISION OF SALIVARY GLAND, BY REPORT
SIALODOCHOPLASTY
CLOSURE OF SALIVARY FISTULA
EMERGENCY TRACHEOTOMY
CORONOIDECTOMY
SYNTHETIC GRAFT-MANDIBLE OR FACIAL BONES, BY REPOR
IMPLANT-MANDIBLE FOR AUGMENTATION PURPOSES (EXCLUD
APPLIANCE REMOVAL (NOT BY DENTIST WHO PLACED APPLI
Intraoral place of fix dev
UNSPECIFIED ORAL SURGERY PROCEDURE, BY REPORT
LIMITED ORTHODONTIC TREATMENT OF THE PRIMARY DENTI
LIMITED ORTHODONTIC TREATMENT OF THE TRANSITIONAL
LIMITED ORTHODONTIC TREATMENT OF THE ADOLESCENT DE
LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITI
INTERCEPTIVE ORTHODONTIC TREATMENT OF THE PRIMARY
INTERCEPTIVE ORTHODONTIC TREATMENT OF THE TRANSITI
COMPREHENSIVE ORTHODONTIC TREATMENT OF THE TRANSIT
COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESC
COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT D
REMOVABLE APPLIANCE THERAPY
FIXED APPLIANCE THERAPY
PREORTHODONTIC TREATMENT VISIT
PERIODIC ORTHODONTIC TREATMENT VISIT (AS PART OF C
ORTHODONTIC RETENTION (REMOVAL OF APPLIANCES, CONS
ORTHODONTIC TREATMENT (ALTERNATIVE BILLING TO A CO
REPAIR OF ORTHODONTIC APPLIANCE
REPLACEMENT OF LOST OR BROKEN RETAINER
REBONDING OR RECEMENTING OF FIXED RETAINER
REPAIR OF FIXED RETAINERS INCLUDES REATTACHMENT
UNSPECIFIED ORTHODONTIC PROCEDURE, BY REPORT
PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN-MI
Fix partial denture section
LOCAL ANESTHESIA N0T IN CONJUNCTION WITH OPERATIV
REGIONAL BLOCK ANESTHESIA
TRIGEMINAL DIVISION BLOCK ANESTHESIA
LOCAL ANESTHESIA CONJUCTION OPERATIVE/SURG PROC
EVALUATION FOR DEEP SEDATION/GENERAL ANESTHESIA
DEEP SEDATION/GENERAL ANESTHESIA; FIRST 30 MINUTES
DEEP SEDATION/GENERAL ANESTHESIA-EACH ADDITIONAL 1
DEEP SEDATION/GENERAL ANESTHESIA - EA 15 MIN
INHALATION OF NITROUS OXIDE/ANXIOLYSIS ANALGESIA
INTRAVENOUS CONSCIOUS SEDATION/ANALGESIA; FIRST 30
INTRAVENOUS CONSCIOUS SEDATION/ANALGESIA - EACH AD
INTRAVENOUS MOD SEDATION/ANALGESIA - EA 15 MIN
NON-INTRAVENOUS CONSCIOUS SEDATION
CONSULTATION (DIAGNOSTIC SERVICE PROVIDED BY DENTI
HOUSE/EXTENDED CARE FACILITY CALL
HOSPITAL OR AMBULATORY SURGICAL CENTER CALL
OFFICE VISIT FOR OBSERVATION (DURING REGULARLY SCH
OFFICE VISIT-AFTER REGULARLY SCHEDULED HOURS
CASE PRESENTATION, DETAILED AND EXTENSIVE TREATMEN
THERAPEUTIC PARENTERAL DRUG, SINGLE ADMINISTRATION
Thera par drugs 2 or > admin
OTHER DRUGS AND/OR MEDICAMENTS, BY REPORT
APPLICATION OF DESENSITIZING MEDICAMENT
APPLICATION OF DESENSITIZING RESIN FOR CERVICAL AN
BEHAVIOR MANAGEMENT, BY REPORT
TREATMENT OF COMPLICATIONS (POSTSURGICAL) - UNUSUA
CLEANING AND INSPECTION OF A REMOVABLE APPLIANCE
OCCLUSAL GUARD BY REPORT
FABRICATION OF ATHLETIC MOUTHGUARD
REPAIR AND/OR RELINE OF OCCLUSAL GUARD
OCCLUSION ANALYSIS-MOUNTED CASE
OCCLUSAL ADJUSTMENT-LIMITED
OCCLUSAL ADJUSTMENT-COMPLETE
ENAMEL MICROABRASION
ODONTOPLASTY 1 - 2 TEETH; INCLUDES REMOVAL OF ENAM
EXTERNAL BLEACHING - PER ARCH
EXTERNAL BLEACHING - PER TOOTH
INTERNAL BLEACHING - PER TOOTH
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2014
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2007
1/1/2004
1/1/2016
1/1/2004
1/1/2007
1/1/2004
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
D9975
D9985
D9986
D9987
D9999
E0100
E0105
E0110
E0111
E0112
E0113
E0114
E0116
E0117
E0118
E0130
E0135
E0140
E0141
E0143
E0144
E0147
E0148
E0149
E0153
E0154
E0155
E0156
E0157
E0158
E0159
E0160
E0161
E0162
E0163
E0165
E0167
E0168
E0170
E0171
E0175
E0181
E0182
E0184
E0185
E0186
E0187
E0188
E0189
E0190
E0191
E0193
E0194
E0196
E0197
E0198
E0199
E0200
E0202
E0203
E0205
E0210
E0215
E0217
E0218
E0221
E0225
E0231
E0232
E0235
E0236
E0239
E0240
E0241
E0242
E0243
E0244
E0245
E0246
E0247
E0248
E0249
E0250
E0251
E0255
E0256
E0260
E0261
E0265
E0266
E0270
EXT BLEACH HOM APPLIC-ARCH; MATL FAB CSTM TRAYS
SALES TAX
MISSED APPOINTMENT
CANCELLED APPOINTMENT
UNSPECIFIED ADJUNCTIVE PROCEDURE, BY REPORT
CANE, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE
CANE, QUAD OR THREE PRONG, INCLUDES CANES OF ALL M
CRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS MA
CRUTCH FOREARM, INCLUDES CRUTCHES OF VARIOUS MATER
CRUTCHES UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR
CRUTCH UNDERARM, WOOD, ADJUSTABLE OR FIXED, EACH,
CRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR
CRUTCH UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FI
CRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, E
CRUTCH SUBSTITUTE, LOWER LEG PLATFORM, WITH OR WIT
WALKER, RIGID (PICKUP), ADJUSTABLE OR FIXED HEIGHT
WALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIG
WALKER, WITH TRUNK SUPPORT, ADJUSTABLE OR FIXED HE
WALKER, RIGID, WHEELED, ADJUSTABLE OR FIXED HEIGHT
WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIG
WALKER, ENCLOSED, FOUR SIDED FRAMED, RIGID OR FOLD
WALKER, HEAVY DUTY, MULTIPLE BRAKING SYSTEM, VARIA
WALKER, HEAVY DUTY, WITHOUT WHEELS, RIGID OR FOLDI
WALKER, HEAVY DUTY, WHEELED, RIGID OR FOLDING, ANY
PLATFORM ATTACHMENT, FOREARM CRUTCH, EACH
PLATFORM ATTACHMENT, WALKER, EACH
WHEEL ATTACHMENT, RIGID PICK-UP WALKER, PER PAIR
SEAT ATTACHMENT, WALKER
CRUTCH ATTACHMENT, WALKER, EACH
LEG EXTENSIONS FOR WALKER, PER SET OF FOUR (4)
BRAKE ATTACHMENT FOR WHEELED WALKER, REPLACEMENT,
SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH O
SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH O
SITZ BATH CHAIR
COMMODE CHAIR, STATIONARY, WITH FIXED ARMS
COMMODE CHAIR, STATIONARY, WITH DETACHABLE ARMS
PAIL OR PAN FOR USE WITH COMMODE CHAIR
COMMODE CHAIR, EXTRA WIDE AND/OR HEAVY DUTY, STATI
Commode chair with integrated seat lift mechanism
Commode chair with integrated seat lift mechanism
FOOT REST, FOR USE WITH COMMODE CHAIR, EACH
PRESSURE PAD, ALTERNATING WITH PUMP, HEAVY DUTY
PUMP FOR ALTERNATING PRESSURE PAD
DRY PRESSURE MATTRESS
GEL OR GEL-LIKE PRESSURE PAD FOR MATTRESS, STANDAR
AIR PRESSURE MATTRESS
WATER PRESSURE MATTRESS
SYNTHETIC SHEEPSKIN PAD
LAMBSWOOL SHEEPSKIN PAD, ANY SIZE
POSITIONING CUSHION/PILLOW/WEDGE, ANY SHAPE OR SIZ
HEEL OR ELBOW PROTECTOR, EACH
POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY)
AIR FLUIDIZED BED
GEL PRESSURE MATTRESS
AIR PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS L
WATER PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS
DRY PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS L
HEAT LAMP, WITHOUT STAND (TABLE MODEL), INCLUDES B
PHOTOTHERAPY (BILIRUBIN) LIGHT WITH PHOTOMETER
THERAPEUTIC LIGHTBOX, MINIMUM 10,000 LUX, TABLE TO
HEAT LAMP, WITH STAND, INCLUDES BULB, OR INFRARED
ELECTRIC HEAT PAD, STANDARD
ELECTRIC HEAT PAD, MOIST
WATER CIRCULATING HEAT PAD WITH PUMP
WATER CIRCULATING COLD PAD WITH PUMP
INFRARED HEATING PAD SYSTEM
HYDROCOLLATOR UNIT, INCLUDES PADS
NON-CONTACT WOUND WARMING DEVICE (TEMPERATURE CONT
WARMING CARD FOR USE WITH THE NON CONTACT WOUND WA
PARAFFIN BATH UNIT, PORTABLE (SEE MEDICAL SUPPLY C
PUMP FOR WATER CIRCULATING PAD
HYDROCOLLATOR UNIT, PORTABLE
BATH/SHOWER CHAIR, WITH OR WITHOUT WHEELS, ANY SIZ
BATH TUB WALL RAIL, EACH
BATH TUB RAIL, FLOOR BASE
TOILET RAIL, EACH
RAISED TOILET SEAT
TUB STOOL OR BENCH
TRANSFER TUB RAIL ATTACHMENT
TRANSFER BENCH FOR TUB OR TOILET WITH OR WITHOUT C
TRANSFER BENCH, HEAVY DUTY, FOR TUB OR TOILET WITH
PAD FOR WATER CIRCULATING HEAT UNIT
HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAI
HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAI
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYP
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYP
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTM
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTM
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGH
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGH
HOSPITAL BED, INSTITUTIONAL TYPE INCLUDES: OSCILLA
1/1/2013
1/1/2004
1/1/2015
1/1/2015
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
E0271
E0272
E0273
E0274
E0275
E0276
E0277
E0280
E0290
E0291
E0292
E0293
E0294
E0295
E0296
E0297
E0300
E0301
E0302
E0303
E0304
E0305
E0310
E0315
E0316
E0325
E0326
E0328
E0329
E0350
E0352
E0370
E0371
E0372
E0373
E0424
E0425
E0430
E0431
E0433
E0434
E0435
E0439
E0440
E0441
E0442
E0443
E0444
E0445
E0446
E0450
E0455
E0457
E0459
E0460
E0461
E0462
E0463
E0464
E0465
E0466
E0470
E0471
E0472
E0480
E0481
E0482
E0483
E0484
E0485
E0486
E0487
E0500
E0550
E0555
E0560
E0561
E0562
E0565
E0570
E0572
E0574
E0575
E0580
E0585
E0600
E0601
E0602
E0603
E0604
E0605
MATTRESS, INNERSPRING
MATTRESS, FOAM RUBBER
BED BOARD
OVER-BED TABLE
BED PAN, STANDARD, METAL OR PLASTIC
BED PAN, FRACTURE, METAL OR PLASTIC
POWERED PRESSURE-REDUCING AIR MATTRESS
BED CRADLE, ANY TYPE
HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WI
HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WI
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE
HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTM
HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTM
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGH
HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGH
PEDIATRIC CRIB, HOSPITAL GRADE, FULLY ENCLOSED
HOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT
HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH W
HOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT
HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH W
BED SIDE RAILS, HALF LENGTH
BED SIDE RAILS, FULL LENGTH
BED ACCESSORY: BOARD, TABLE, OR SUPPORT DEVICE, AN
SAFETY ENCLOSURE FRAME/CANOPY FOR USE WITH HOSPITA
URINAL; MALE, JUG-TYPE, ANY MATERIAL
URINAL; FEMALE, JUG-TYPE, ANY MATERIAL
HOSPITAL BED PEDIATRIC MANUAL INCLUDES MATTRESS
HOSPITAL BED PEDIATRIC ELECTRIC INCLUDE MATTRESS
CONTROL UNIT FOR ELECTRONIC BOWEL IRRIGATION/EVACU
DISPOSABLE PACK (WATER RESERVOIR BAG, SPECULUM, VA
AIR PRESSURE ELEVATOR FOR HEEL
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR
POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRES
NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS
STATIONARY COMPRESSED GASEOUS OXYGEN SYSTEM, RENTA
STATIONARY COMPRESSED GAS SYSTEM, PURCHASE; INCLUD
PORTABLE GASEOUS OXYGEN SYSTEM, PURCHASE; INCLUDES
PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES P
PORTABL LIQUID OXYGEN SYS RENTAL; HOME LIQUEFIER
PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES PO
PORTABLE LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDES
STATIONARY LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES
STATIONARY LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDE
OXYGEN CONTENTS, GASEOUS (FOR USE WITH OWNED GASEO
OXYGEN CONTENTS, LIQUID (FOR USE WITH OWNED LIQUID
PORTABLE OXYGEN CONTENTS, GASEOUS (FOR USE ONLY WI
PORTABLE OXYGEN CONTENTS, LIQUID (FOR USE ONLY WIT
OXIMETER DEVICE FOR MEASURING BLOOD OXYGEN LEVELS
TOPICAL OXYGEN DELIVERY SYSTEM NOS INCL SUPPLIES
VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPOR
OXYGEN TENT, EXCLUDING CROUP OR PEDIATRIC TENTS
CHEST SHELL (CUIRASS)
CHEST WRAP
NEGATIVE PRESSURE VENTILATOR; PORTABLE OR STATION
VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPOR
ROCKING BED WITH OR WITHOUT SIDE RAILS
PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MO
PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MO
HOME VENTILATOR, ANY TYPE, USED WITH INVASIVE INTERFACE, (E.G., TRACHEOSTOMY TUBE
HOME VENTILATOR, ANY TYPE, USED WITH NON-INVASIVE INTERFACE, (E.G., MASK, CHEST SH
RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPAB
RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPAB
RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPAB
PERCUSSOR, ELECTRIC OR PNEUMATIC, HOME MODEL
INTRAPULMONARY PERCUSSIVE VENTILATION SYSTEM AND R
COUGH STIMULATING DEVICE, ALTERNATING POSITIVE AND
HIGH FREQUENCY CHEST WALL OSCILLATION AIR-PULSE GE
OSCILLATORY POSITIVE EXPIRATORY PRESSURE DEVICE, N
ORAL DEVICE/APPLIANCE PREFAB, USED TO REDUCE UPPER
ORAL DEVICE/APPLIANCE CUSTOM USED TO REDUCE UPPER
SPIROMETER ELECTRONIC INCLUDES ALL ACCESSORIES
IPPB MACHINE, ALL TYPES, WITH BUILT-IN NEBULIZATI
HUMIDIFIER, DURABLE FOR EXTENSIVE SUPPLEMENTAL HUM
HUMIDIFIER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC
HUMIDIFIER, DURABLE FOR SUPPLEMENTAL HUMIDIFICATIO
HUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY
HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRES
COMPRESSOR, AIR POWER SOURCE FOR EQUIPMENT WHICH I
NEBULIZER, WITH COMPRESSOR
AEROSOL COMPRESSOR, ADJUSTABLE PRESSURE, LIGHT DUT
ULTRASONIC/ELECTRONIC AEROSOL GENERATOR WITH SMALL
NEBULIZER, ULTRASONIC, LARGE VOLUME
NEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC,
NEBULIZER, WITH COMPRESSOR AND HEATER
RESPIRATORY SUCTION PUMP, HOME MODEL, PORTABLE OR
CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE
BREAST PUMP, MANUAL, ANY TYPE
BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE
BREAST PUMP, HEAVY DUTY, HOSPITAL GRADE, PISTON OP
VAPORIZER, ROOM TYPE
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
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1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
E0606
E0607
E0610
E0615
E0616
E0617
E0618
E0619
E0620
E0621
E0625
E0627
E0628
E0629
E0630
E0635
E0636
E0637
E0638
E0639
E0640
E0641
E0642
E0650
E0651
E0652
E0655
E0656
E0657
E0660
E0665
E0666
E0667
E0668
E0669
E0670
E0671
E0672
E0673
E0675
E0676
E0691
E0692
E0693
E0694
E0700
E0705
E0710
E0720
E0730
E0731
E0740
E0744
E0745
E0746
E0747
E0748
E0749
E0755
E0760
E0761
E0762
E0764
E0765
E0766
E0769
E0770
E0776
E0779
E0780
E0781
E0782
E0783
E0784
E0785
E0786
E0791
E0830
E0840
E0849
E0850
E0855
E0856
E0860
E0870
E0880
E0890
E0900
E0910
E0911
E0912
POSTURAL DRAINAGE BOARD
HOME BLOOD GLUCOSE MONITOR
PACEMAKER MONITOR, SELF-CONTAINED, (CHECKS BATTERY
PACEMAKER MONITOR, SELF CONTAINED, CHECKS BATTERY
IMPLANTABLE CARDIAC EVENT RECORDER WITH MEMORY, AC
EXTERNAL DEFIBRILLATOR WITH INTEGRATED ELECTROCARD
APNEA MONITOR, WITHOUT RECORDING FEATURE
APNEA MONITOR, WITH RECORDING FEATURE
SKIN PIERCING DEVICE FOR COLLECTION OF CAPILLARY B
SLING OR SEAT, PATIENT LIFT, CANVAS OR NYLON
PATIENT LIFT, BATHROOM OR TOILET, NOT OTHERWISE CL
SEAT LIFT MECHANISM INCORPORATED INTO A COMBINATIO
SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT
SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT
PATIENT LIFT, HYDRAULIC, WITH SEAT OR SLING
PATIENT LIFT, ELECTRIC WITH SEAT OR SLING
MULTIPOSITIONAL PATIENT SUPPORT SYSTEM, WITH INTEG
COMB SIT STAND FRAME/TABLE SYS SEATLIFT FEATURE
STANDING FRAME/TABLE SYS ONE POSITION ANY SZ
PATIENT LIFT, MOVEABLE FROM ROOM TO ROOM WITH DISA
PATIENT LIFT, FIXED SYSTEM, INCLUDES ALL COMPONENT
STANDING FRAME/TABLESYSTEM, MULTI-POSITION (E.G. THREE-WAY STANDER), ANY SIZE INC
STANDING FRAME/TABLE SYSTEM, MOBILE (DYNAMIC STANDER), ANY SIZE INCLUDING PEDIAT
PNEUMATIC COMPRESSOR, NON-SEGMENTAL HOME MODEL
PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITHOUT
PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITH CA
NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNE
SEG PNEUMAT APPLIANCE USE W/PNEUMAT COMPRS TRUNK
SEG PNEUMAT APPLIANCE USE W/PNEUMAT COMPRS CHEST
NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNE
NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNE
NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNE
SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMAT
SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMAT
SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMAT
SEG PNEU APPLINC PNEU COMPRS IN 2 FULL LEGS TRNK
SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, F
SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, F
SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, H
PNEUMATIC COMPRESSION DEVICE, HIGH PRESSURE, RAPID
Inter limb compress dev NOS
UV LIGHT TX SYS BULB/LAMP TIMER; TX 2 SQ FT/LESS
ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES B
ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES B
ULTRAVIOLET MULTIDIRECTIONAL LIGHT THERAPY SYSTEM
SAFETY EQUIPMENT (E.G., BELT, HARNESS OR VEST)
TRANSFER BOARD OR DEVICE, ANY TYPE, EACH
RESTRAINTS, ANY TYPE (BODY, CHEST, WRIST OR ANKLE)
TENS, TWO LEAD, LOCALIZED STIMULATION
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION DEVICE
FORM FITTING CONDUCTIVE GARMENT FOR DELIVERY OF TE
INCONTINENCE TREATMENT SYSTEM, PELVIC FLOOR STIMUL
NEUROMUSCULAR STIMULATOR FOR SCOLIOSIS
NEUROMUSCULAR STIMULATOR, ELECTRONIC SHOCK UNIT
ELECTROMYOGRAPHY (EMG), BIOFEEDBACK DEVICE
OSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE,
OSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE,
OSTEOGENESIS STIMULATOR, ELECTRICAL, SURGICALLY IM
ELECTRONIC SALIVARY REFLEX STIMULATOR (INTRA-ORAL/
OSTOGENESIS STIMULATOR, LOW INTENSITY ULTRASOUND,
NON-THERMAL PULSED HIGH FREQUENCY RADIOWAVES, HIGH
Transcutaneous electrical joint stimulation device
Functional neuromuscular stimulator, transcutaneou
FDA APPROVED NERVE STIMULATOR, WITH REPLACEABLE BA
ELEC STIM DVC U CANCER TX INCL ALL ACC ANY TYPE
ELECTRICAL STIMULATION OR ELECTROMAGNETIC WOUND TR
FES TRANSQ STIM NERV&/MUSC GRP CMPL SYS NOS
IV POLE
AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FO
AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FO
AMBULATORY INFUSION PUMP, SINGLE OR MULTIPLE CHANN
INFUSION PUMP, IMPLANTABLE, NON-PROGRAMMABLE (INCL
INFUSION PUMP SYSTEM, IMPLANTABLE, PROGRAMMABLE (I
EXTERNAL AMBULATORY INFUSION PUMP, INSULIN
IMPLANTABLE INTRASPINAL (EPIDURAL/INTRATHECAL) CAT
IMPLANTABLE PROGRAMMABLE INFUSION PUMP, REPLACEMEN
PARENTERAL INFUSION PUMP, STATIONARY, SINGLE OR MU
AMBULATORY TRACTION DEVICE, ALL TYPES, EACH
TRACTION FRAME, ATTACHED TO HEADBOARD, CERVICAL TR
TRACTION EQUIPMENT, CERVICAL, FREE-STANDING STAND/
TRACTION STAND, FREE STANDING, CERVICAL TRACTION
CERVICAL TRACTION EQUIPMENT NOT REQUIRING ADDITION
CERVICAL TRACTION DEVICE INFLATABLE AIR BLADDER
TRACTION EQUIPMENT, OVERDOOR, CERVICAL
TRACTION FRAME, ATTACHED TO FOOTBOARD, EXTREMITY T
TRACTION STAND, FREE STANDING, EXTREMITY TRACTION,
TRACTION FRAME, ATTACHED TO FOOTBOARD, PELVIC TRAC
TRACTION STAND, FREE STANDING, PELVIC TRACTION, (E
TRAPEZE BARS, A/K/A PATIENT HELPER, ATTACHED TO BE
Trapeze bar, heavy duty, for patient weight capaci
Trapeze bar, heavy duty, for patient weight capaci
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2014
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2013
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2004
1/1/2014
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
Y
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
E0920
E0930
E0935
E0936
E0940
E0941
E0942
E0944
E0945
E0946
E0947
E0948
E0950
E0951
E0952
E0955
E0956
E0957
E0958
E0959
E0960
E0961
E0966
E0967
E0968
E0969
E0970
E0971
E0973
E0974
E0978
E0980
E0981
E0982
E0983
E0984
E0985
E0986
E0988
E0990
E0992
E0994
E0995
E1002
E1003
E1004
E1005
E1006
E1007
E1008
E1009
E1010
E1011
E1012
E1014
E1015
E1016
E1017
E1018
E1020
E1028
E1029
E1030
E1031
E1035
E1036
E1037
E1038
E1039
E1050
E1060
E1070
E1083
E1084
E1085
E1086
E1087
E1088
E1089
E1090
E1092
E1093
E1100
E1110
E1130
E1140
E1150
E1160
E1161
E1170
E1171
FRACTURE FRAME, ATTACHED TO BED, INCLUDES WEIGHTS
FRACTURE FRAME, FREE STANDING, INCLUDES WEIGHTS
PASSIVE MOTION EXERCISE DEVICE
CPM device, other than knee
TRAPEZE BAR, FREE STANDING, COMPLETE WITH GRAB BAR
GRAVITY ASSISTED TRACTION DEVICE, ANY TYPE
CERVICAL HEAD HARNESS/HALTER
PELVIC BELT/HARNESS/BOOT
EXTREMITY BELT/HARNESS
FRACTURE, FRAME, DUAL WITH CROSS BARS, ATTACHED TO
FRACTURE FRAME, ATTACHMENTS FOR COMPLEX PELVIC TRA
FRACTURE FRAME, ATTACHMENTS FOR COMPLEX CERVICAL T
WHEELCHAIR ACCESSORY, TRAY, EACH
HEEL LOOP/HOLDER, ANY TYPE, WITH OR WITHOUT ANKLE
TOE LOOP/HOLDER, ANY TYPE, EACH
WHEELCHAIR ACCESSORY, HEADREST, CUSHIONED, ANY TYP
WHEELCHAIR ACCESSORY, LATERAL TRUNK OR HIP SUPPORT
WHEELCHAIR ACCESSORY, MEDIAL THIGH SUPPORT, ANY TY
MANUAL WHEELCHAIR ACCESSORY, ONE-ARM DRIVE ATTACHM
MANUAL WHEELCHAIR ACCESSORY, ADAPTER FOR AMPUTEE,
WHEELCHAIR ACCESSORY, SHOULDER HARNESS/STRAPS OR C
MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK BRAKE EXTE
MANUAL WHEELCHAIR ACCESSORY, HEADREST EXTENSION, E
MANUAL WHEELCHAIR ACCESSORY, HAND RIM WITH PROJECT
COMMODE SEAT, WHEELCHAIR
NARROWING DEVICE, WHEELCHAIR
NO.2 FOOTPLATES, EXCEPT FOR ELEVATING LEG REST
Anti-tipping device, wheelchair
WHEELCHAIR ACCESSORY, ADJUSTABLE HEIGHT, DETACHABL
MANUAL WHEELCHAIR ACCESSORY, ANTI-ROLLBACK DEVICE,
WHEELCHAIR ACCESSORY, POSITIONING BELT/SAFETY BEL
SAFETY VEST, WHEELCHAIR
WHEELCHAIR ACCESSORY, SEAT UPHOLSTERY, REPLACEMENT
WHEELCHAIR ACCESSORY, BACK UPHOLSTERY, REPLACEMENT
MANUAL WHEELCHAIR ACCESSORY, POWER ADD-ON TO CONVE
MANUAL WHEELCHAIR ACCESSORY, POWER ADD-ON TO CONVE
WHEELCHAIR ACCESSORY, SEAT LIFT MECHANISM
MNL WHEELCHAIR ACSS PUSH-RIM ACT PWR ASSIST SYS
MANUAL WC ACCESSORY LEVR-ACTIVATD WHL DRIVE PAIR
WHEELCHAIR ACCESSORY, ELEVATING LEG REST, COMPLETE
MANUAL WHEELCHAIR ACCESSORY, SOLID SEAT INSERT
ARM REST, EACH
WHEELCHAIR ACCESSORY, CALF REST/PAD, EACH
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, TILT O
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLIN
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLIN
WHEELCHAIR ACCESSORY, POWER SEATNG SYSTEM, RECLINE
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBIN
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBIN
WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBIN
WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SY
WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SY
MODIFICATION TO PEDIATRIC SIZE WHEELCHAIR, WIDTH A
WC ACCSS PWR SEAT SYS CNTR MNT PWR ELEV LEG EA
RECLINING BACK, ADDITION TO PEDIATRIC SIZE WHEELCH
SHOCK ABSORBER FOR MANUAL WHEELCHAIR, EACH
SHOCK ABSORBER FOR POWER WHEELCHAIR, EACH
HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY OR EXTRA
HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY OR EXTRA
RESIDUAL LIMB SUPPORT SYSTEM FOR WHEELCHAIR
WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABL
WHEELCHAIR ACCESSORY, VENTILATOR TRAY, FIXED
WHEELCHAIR ACCESSORY, VENTILATOR TRAY, GIMBALED
ROLLABOUT CHAIR, ANY AND ALL TYPES WITH CASTORS 5"
MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, WITH INT
MULTI-PSTN PT TRNSF SYS EXTRA WIDE PT >300 LBS
TRANSPORT CHAIR, PEDIATRIC SIZE
TRANSPORT CHAIR, ADULT SIZE, PATIENT WEIGHT CAPACI
TRANSPORT CHAIR, ADULT SIZE, HEAVY DUTY, PATIENT W
FULLY-RECLINING WHEELCHAIR, FIXED FULL LENGTH ARMS
FULLY-RECLINING WHEELCHAIR, DETACHABLE ARMS, DESK
FULLY-RECLINING WHEELCHAIR, DETACHABLE ARMS (DESK
HEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWA
HEMI-WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENG
HEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWA
HEMI-WHEELCHAIR DETACHABLE ARMS DESK OR FULL LENGT
HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED FULL L
HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE A
HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED LENGTH
HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE A
WIDE HEAVY DUTY WHEEL CHAIR, DETACHABLE ARMS (DESK
WIDE HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS DESK O
SEMI-RECLINING WHEELCHAIR, FIXED FULL LENGTH ARMS,
SEMI-RECLINING WHEELCHAIR, DETACHABLE ARMS (DESK O
STANDARD WHEELCHAIR, FIXED FULL LENGTH ARMS, FIXED
WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH,
WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH S
WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DET
MANUAL ADULT SIZE WHEELCHAIR, INCLUDES TILT IN SPA
AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING
AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, WITHOU
1/1/2004
1/1/2004
1/1/2004
1/1/2007
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
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1/1/2004
1/1/2004
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1/1/2004
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1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2016
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2010
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
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12/31/9999
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12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
Y
Y
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
E1172
E1180
E1190
E1195
E1200
E1220
E1221
E1222
E1223
E1224
E1225
E1226
E1227
E1228
E1229
E1230
E1231
E1232
E1233
E1234
E1235
E1236
E1237
E1238
E1239
E1240
E1250
E1260
E1270
E1280
E1285
E1290
E1295
E1296
E1297
E1298
E1300
E1310
E1352
E1353
E1354
E1355
E1356
E1357
E1358
E1372
E1390
E1391
E1392
E1399
E1405
E1406
E1500
E1510
E1520
E1530
E1540
E1550
E1560
E1570
E1575
E1580
E1590
E1592
E1594
E1600
E1610
E1615
E1620
E1625
E1630
E1632
E1634
E1635
E1636
E1637
E1639
E1699
E1700
E1701
E1702
E1800
E1801
E1802
E1805
E1806
E1810
E1811
E1812
E1815
E1816
AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL
AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL
AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL
HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, SWI
AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING
WHEELCHAIR; SPECIALLY SIZED OR CONSTRUCTED, (INDIC
WHEELCHAIR WITH FIXED ARM, FOOTRESTS
WHEELCHAIR WITH FIXED ARM, ELEVATING LEGRESTS
WHEELCHAIR WITH DETACHABLE ARMS, FOOTRESTS
WHEELCHAIR WITH DETACHABLE ARMS, ELEVATING LEGREST
WHEELCHAIR ACCESSORY, MANUAL SEMI-RECLINING BACK,
WHEELCHAIR ACCESSORY, MANUAL FULLY RECLINING BACK,
SPECIAL HEIGHT ARMS FOR WHEELCHAIR
SPECIAL BACK HEIGHT FOR WHEELCHAIR
WHEELCHAIR, PEDIATRIC SIZE, NOT OTHERWISE SPECIFIE
POWER OPERATED VEHICLE (THREE OR FOUR WHEEL NONHIG
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID,
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID,
WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING
WHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WIT
WHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, W
WHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WIT
WHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, W
POWER WHEELCHAIR, PEDIATRIC SIZE, NOT OTHERWISE SP
LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS, (DESK OR
LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SW
LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS (DESK OR F
LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SW
HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS (DESK OR FU
HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, SWI
HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS (DESK OR FU
HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, ELE
SPECIAL WHEELCHAIR SEAT HEIGHT FROM FLOOR
SPECIAL WHEELCHAIR SEAT DEPTH, BY UPHOLSTERY
SPECIAL WHEELCHAIR SEAT DEPTH AND/OR WIDTH, BY CON
WHIRLPOOL, PORTABLE (OVERTUB TYPE)
WHIRLPOOL, NON-PORTABLE (BUILT-IN TYPE)
OXYGEN ACC FLOW REG CPBL POS INSPIRATORY PRESS
REGULATOR
O2 ACCESS WHEELED CART PRTBLE CYL/CONC REPL EA
STAND/RACK
O2 ACCESS BTTRY PACK/CRTRDGE PRTBLE CONC REPL EA
O2 ACCESS BATTRY CHARGER PRTBLE CONC REPL EA
O2 ACCESS DC POWER ADAPTER PRTBLE CONC REPL EA
IMMERSION EXTERNAL HEATER FOR NEBULIZER
OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE
OXYGEN CONCENTRATOR, DUAL DELIVERY PORT, CAPABLE O
Portable oxygen concentrator, rental
DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS
OXYGEN AND WATER VAPOR ENRICHING SYSTEM WITH HEATE
OXYGEN AND WATER VAPOR ENRICHING SYSTEM WITHOUT HE
CENTRIFUGE, FOR DIALYSIS
KIDNEY, DIALYSATE DELIVERY SYST. KIDNEY MACHINE, P
HEPARIN INFUSION PUMP FOR HEMODIALYSIS
AIR BUBBLE DETECTOR FOR HEMODIALYSIS, EACH, REPLAC
PRESSURE ALARM FOR HEMODIALYSIS, EACH, REPLACEMENT
BATH CONDUCTIVITY METER FOR HEMODIALYSIS, EACH
BLOOD LEAK DETECTOR FOR HEMODIALYSIS, EACH, REPLAC
ADJUSTABLE CHAIR, FOR ESRD PATIENTS
TRANSDUCER PROTECTORS/FLUID BARRIERS, FOR HEMODIAL
UNIPUNCTURE CONTROL SYSTEM FOR HEMODIALYSIS
HEMODIALYSIS MACHINE
AUTOMATIC INTERMITTENT PERITIONEAL DIALYSIS SYSTEM
CYCLER DIALYSIS MACHINE FOR PERITONEAL DIALYSIS
DELIVERY AND/OR INSTALLATION CHARGES FOR HEMODIALY
REVERSE OSMOSIS WATER PURIFICATION SYSTEM, FOR HEM
DEIONIZER WATER PURIFICATION SYSTEM, FOR HEMODIALY
BLOOD PUMP FOR HEMODIALYSIS, REPLACEMENT
WATER SOFTENING SYSTEM, FOR HEMODIALYSIS
RECIPROCATING PERITONEAL DIALYSIS SYSTEM
WEARABLE ARTIFICIAL KIDNEY, EACH
PERITONEAL DIALYSIS CLAMPS, EACH
COMPACT (PORTABLE) TRAVEL HEMODIALYZER SYSTEM
SORBENT CARTRIDGES, FOR HEMODIALYSIS, PER 10
HEMOSTATS, EACH
SCALE, EACH
DIALYSIS EQUIPMENT, NOT OTHERWISE SPECIFIED
JAW MOTION REHABILITATION SYSTEM
REPLACEMENT CUSHIONS FOR JAW MOTION REHABILITATION
REPLACEMENT MEASURING SCALES FOR JAW MOTION REHABI
DYNAMIC ADJUSTABLE ELBOW EXTENSION/FLEXION DEVICE,
BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH ELBOW DE
DYNAMIC ADJUSTABLE FOREARM PRONATION/SUPINATION DE
DYNAMIC ADJUSTABLE WRIST EXTENSION / FLEXION DEVIC
BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH WRIST DE
DYNAMIC ADJUSTABLE KNEE EXTENSION / FLEXION DEVICE
BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH KNEE DEV
DYNAMIC KNEE, EXTENSION/FLEXION DEVICE W/ACTIVE RE
DYNAMIC ADJUSTABLE ANKLE EXTENSION/FLEXION DEVICE,
BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH ANKLE DE
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2014
1/1/2004
1/1/2009
1/1/2004
1/1/2009
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
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12/31/9999
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12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
N
Y
Y
N
Y
N
N
Y
N
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
OUTPT ASC 13X AND 83X & POS 22 OR 24
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
E1818
E1820
E1821
E1825
E1830
E1831
E1840
E1841
E1902
E2000
E2100
E2101
E2120
E2201
E2202
E2203
E2204
E2205
E2206
E2207
E2208
E2209
E2210
E2211
E2212
E2213
E2214
E2215
E2216
E2217
E2218
E2219
E2220
E2221
E2222
E2224
E2225
E2226
E2227
E2228
E2230
E2231
E2291
E2292
E2293
E2294
E2295
E2300
E2301
E2310
E2311
E2312
E2313
E2321
E2322
E2323
E2324
E2325
E2326
E2327
E2328
E2329
E2330
E2331
E2340
E2341
E2342
E2343
E2351
E2358
E2359
E2360
E2361
E2362
E2363
E2364
E2365
E2366
E2367
E2368
E2369
E2370
E2371
E2372
E2373
E2374
E2375
E2376
E2377
E2378
E2381
BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH FOREARM
REPLACEMENT SOFT INTERFACE MATERIAL, DYNAMIC ADJUS
REPLACEMENT SOFT INTERFACE MATERIAL/CUFFS FOR BI-D
DYNAMIC ADJUSTABLE FINGER EXTENSION/FLEXION DEVICE
DYNAMIC ADJUSTABLE TOE EXTENSION/FLEXION DEVICE, I
STATIC PROGRESSIVE STRETCH TOE DEVICE
DYNAMIC ADJUSTABLE SHOULDER FLEXION / ABDUCTION /
MULTI-DIRECTIONAL STATIC PROGRESSIVE STRETCH SHOUL
COMMUNICATION BOARD, NON-ELECTRONIC AUGMENTATIVE O
GASTRIC SUCTION PUMP, HOME MODEL, PORTABLE OR STAT
BLOOD GLUCOSE MONITOR WITH INTEGRATED VOICE SYNTHE
BLOOD GLUCOSE MONITOR WITH INTEGRATED LANCING/BLOO
PULSE GENERATOR SYSTEM FOR TYMPANIC TREATMENT OF I
MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAM
MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAM
MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAM
MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAM
MANUAL WHEELCHAIR ACCESSORY, HANDRIM WITHOUT PROJE
MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK ASSEMBLY,
Wheelchair accessory, crutch and cane holder, each
Wheelchair accessory, cylinder tank carrier, each
Wheelchair accessory, arm trough, each
Wheelchair accessory, bearings, any type replaceme
Manual wheelchair accessory, pneumatic propulsion
Manual wheelchair accessory, tube for pneumatic pr
Manual wheelchair accessory, insert for pneumatic
Manual wheelchair accessory, pneumatic caster tire
Manual wheelchair accessory, tube for pneumatic ca
MANUAL WHEELCHAIR ACCESSORY,FOAM FILLED PROPULSION
MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED CASTER TI
MANUAL WHEELCHAIR ACCESSORY,FOAM PROPULSION TIRE,A
Manual wheelchair accessory, foam caster tire, any
Manual wheelchair accessory, solid (rubber/plastic
Manual wheelchair accessory, solid (rubber/plastic
Manual wheelchair accessory, solid (rubber/plastic
Manual wheelchair accessory, propulsion wheel excl
Manual wheelchair accessory, caster wheel excludes
Manual wheelchair accessory, caster fork, any size
MANUAL WC ACCESS GEAR REDUCTION DRIVE WHEEL EACH
MNL WC ACCESS WHEEL BRAKING SYS&LOCK COMPLETE EA
MANUAL WHEELCHAIR ACCESSORY MANUAL STANDING SYS
MNL WC ACCESS SOLID SEAT SUPP BASE INCL HARDWARE
BACK, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUD
SEAT, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUD
BACK, CONTOURED, FOR PEDIATRIC SIZE WHEELCHAIR INC
SEAT, CONTOURED, FOR PEDIATRIC SIZE WHEELCHAIR INC
MNL WC ACCESS PED SIZE WC DYNAMIC SEATING FRAME
WHEELCHAIR ACC PWR SEAT ELEVATION SYS ANY TYPE
WHEELCHAIR ACCESSORY POWER STANDING SYS ANY TYPE
POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION
POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION
POWER WC ACCESS HAND OR CHIN CONTROL INTERFACE
POWER WC ACCESS HARNESS UPGRADE EXP CONTROLLR EA
POWER WHEELCHAIR ACCESSORY, HAND CONTROL INTERFACE
POWER WHEELCHAIR ACCESSORY, HAND CONTROL INTERFACE
POWER WHEELCHAIR ACCESSORY, SPECIALTY JOYSTICK HAN
POWER WHEELCHAIR ACCESSORY, CHIN CUP FOR CHIN CONT
POWER WHEELCHAIR ACCESSORY, SIP AND PUFF INTERFACE
POWER WHEELCHAIR ACCESSORY, BREATH TUBE KIT FOR SI
POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE
POWER WHEELCHAIR ACCESSORY, HEAD CONTROL OR EXTREM
POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE
POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE
POWER WHEELCHAIR ACCESSORY, ATTENDANT CONTROL, PRO
POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME
POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME
POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME
POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME
POWER WHEELCHAIR ACCESSORY, ELECTRONIC INTERFACE T
PWR WC ACCESS GRP 34 NONSEALED LEAD ACID BATT EA
PWR WC ACCESSORY GRP 34 SEALED LEAD ACID BATT EA
POWER WHEELCHAIR ACCESSORY, 22 NF NON-SEALED LEAD
POWER WHEELCHAIR ACCESSORY, 22NF SEALED LEAD ACID
POWER WHEELCHAIR ACCESSORY, GROUP 24 NON-SEALED LE
POWER WHEELCHAIR ACCESSORY, GROUP 24 SEALED LEAD A
POWER WHEELCHAIR ACCESSORY, U-1 NON-SEALED LEAD AC
POWER WHEELCHAIR ACCESSORY, U-1 SEALED LEAD ACID B
POWER WHEELCHAIR ACCESSORY, BATTERY CHARGER, SINGL
POWER WHEELCHAIR ACCESSORY, BATTERY CHARGER, DUAL
POWER WHEELCHAIR COMPONENT, MOTOR, REPLACEMENT ONL
POWER WHEELCHAIR COMPONENT, GEAR BOX, REPLACEMENT
POWER WHEELCHAIR COMPONENT, MOTOR AND GEAR BOX COM
Power wheelchair accessory, group 27 sealed lead a
POWER WHEELCHAIR ACCESSORY,GROUP 27 NON-SEALED LEA
Hand/chin ctrl spec joystick
Hand/chin ctrl std joystick
Non-expandable controller
Expandable controller, repl
Expandable controller, initl
POWER WHEELCHAIR COMPONENT ACTUATOR REPLACE ONLY
Pneum drive wheel tire
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2006
1/1/2008
1/1/2008
1/1/2009
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2009
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2008
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2006
1/1/2006
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2013
1/1/2007
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Y
N
N
Y
N
N
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
N
N
N
N
N
N
N
N
Y
Y
N
Y
Y
N
N
Y
N
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
HCPC
E2382
E2383
E2384
E2385
E2386
E2387
E2388
E2389
E2390
E2391
E2392
E2394
E2395
E2396
E2397
E2402
E2500
E2502
E2504
E2506
E2508
E2510
E2511
E2512
E2599
E2601
E2602
E2603
E2604
E2605
E2606
E2607
E2608
E2609
E2610
E2611
E2612
E2613
E2614
E2615
E2616
E2617
E2619
E2620
E2621
E2622
E2623
E2624
E2625
E2626
E2627
E2628
E2629
E2630
E2631
E2632
E2633
E8000
E8001
E8002
G0008
G0009
G0010
G0027
G0101
G0102
G0103
G0104
G0105
G0106
G0108
G0109
G0117
G0118
G0120
G0121
G0122
G0123
G0124
G0127
G0128
G0129
G0130
G0141
G0143
G0144
G0145
G0147
G0148
G0151
G0152
Tube, pneum wheel drive tire
Insert, pneum wheel drive
Pneumatic caster tire
Tube, pneumatic caster tire
Foam filled drive wheel tire
Foam filled caster tire
Foam drive wheel tire
Foam caster tire
Solid drive wheel tire
Solid caster tire
Solid caster tire, integrate
Drive wheel excludes tire
Caster wheel excludes tire
Caster fork
POWER WHLCHAIR ACCESSORY LITHIUM-BASED BATTRY EA
NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, S
SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING
SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING
SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING
SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING
SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, REQU
SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, PERM
SPEECH GENERATING SOFTWARE PROGRAM, FOR PERSONAL C
ACCESSORY FOR SPEECH GENERATING DEVICE, MOUNTING S
ACCESSORY FOR SPEECH GENERATING DEVICE, NOT OTHERW
GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH LESS TH
GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH 22 INCH
SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH LES
SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH 22
POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS TH
POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCH
SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CU
SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CU
CUSTOM FABRICATED WHEELCHAIR SEAT CUSHION, ANY SIZ
WHEELCHAIR SEAT CUSHION, POWERED
GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH LESS TH
GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH 22 INCH
POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WI
POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WI
POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LAT
POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LAT
CUSTOM FABRICATED WHEELCHAIR BACK CUSHION, ANY SIZ
REPLACEMENT COVER FOR WHEELCHAIR SEAT CUSHION OR B
POSITIONING WHEELCHAIR BACK CUSHION, PLANAR BACK W
POSITIONING WHEELCHAIR BACK CUSHION, PLANAR BACK W
SKIN PROTECT WC SEAT CUSH WIDTH <22 IN ANY DEPTH
SKIN PROTCT WC SEAT CUSH WIDTH 22 IN/> ANY DEPTH
SKIN PROTECT & POSITIONING WC CUSH WIDTH < 22 IN
SKIN PROTECT & POSITIONING WC CUSH WIDTH 22 IN/>
WC ACCESS SHLDR ELB MOBIL ARM SUPP WC ADJUSTBLE
WC ACCESS SHLDR ELB M ARM SUPP ADJUSTBL RANCHO
WC ACCESS SHLDR ELB MOBIL ARM SUPP WC RECLINING
WC ACCESS SHLDR ELB M ARM SUPP FRICTION ARM SUPP
WC ACCESS SHLDR ELB MOBIL MONOSUSP ARM HAND SUPP
WC ACCESS ADD MOBILE ARM SUPPORT ELEV PROX ARM
WC ACCESS ADD MOBIL ARM SUPP OFFSET/LAT RCKR ARM
WC ACCESS ADD MOBILE ARM SUPPORT SUPINATOR
GAIT TRAINER, PEDIATRIC SIZE, POSTERIOR SUPPORT, I
GAIT TRAINER, PEDIATRIC SIZE, UPRIGHT SUPPORT, INC
GAIT TRAINER, PEDIATRIC SIZE, ANTERIOR SUPPORT, IN
ADMINISTRATION OF INFLUENZA VIRUS VACCINE
ADMINISTRATION OF PNEUMOCOCCAL VACCINE
ADMINISTRATION OF HEPATITIS B VACCINE
SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM
CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND C
PROSTATE CANCER SCREENING; DIGITAL RECTAL EXAMINAT
PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIG
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOP
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVI
COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0104,
DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVI
DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVI
GLAUCOMA SCREENING FOR HIGH RISK PATIENTS FURNISHE
GLAUCOMA SCREENING FOR HIGH RISK PATIENT FURNISHED
COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0105,
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVI
COLORECTAL CANCER SCREENING; BARIUM ENEMA
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY
TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER
DIRECT (FACE-TO-FACE WITH PATIENT) SKILLED NURSING
OCCUPATIONAL THERAPY REQUIRING THE SKILLS OF A QUA
SINGLE ENERGY X-RAY ABSORPTIOMETRY (SEXA) BONE DEN
SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINA
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY
SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGIN
SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINA
SERVICE PHYS THERAP HOME HLTH/HOSPICE EA 15 MIN
SERVICE OCCUP THERAP HOME HLTH/HOSPICE EA 15 MIN
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2007
1/1/2008
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2011
1/1/2011
1/1/2011
1/1/2011
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2012
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
1/1/2004
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/3